MEDICARE: DIANA LEIGH WALTON MCKINNON M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	MA055424	PA
2	363AM0700X	Medical Physician Assistant	PA09098	TX
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207Q00000X	Family Medicine Physician	MD494739	PA

General Provider Information

NPI Number	:	1447506407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA LEIGH WALTON MCKINNON M.D

Provider Business Mailing Address
First Line	:	3600 FORBES AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15213-3410
Country	:	US
Telephone Number	:	530-758-1563
Fax Number	:	530-758-2589

Provider Business Practice Location Address
First Line	:	5475 PENN AVE.
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15206
Country	:	US
Telephone Number	:	412-361-7562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2012
Last Update Date	:	04/20/2026

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