MEDICARE: DR. PAUL MICHAEL DIAMOND MD

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	207R00000X	Internal Medicine Physician	25MA03758200	NJ

General Provider Information

NPI Number	:	1518920461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL MICHAEL DIAMOND MD

Provider Business Mailing Address
First Line	:	205 N WASHINGTON AVE
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-1359
Country	:	US
Telephone Number	:	201-384-9255
Fax Number	:	201-384-2758

Provider Business Practice Location Address
First Line	:	205 N WASHINGTON AVE
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-1359
Country	:	US
Telephone Number	:	201-384-9255
Fax Number	:	201-384-2758

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	07/08/2007

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