MEDICARE: DIANE TALLO 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	35-03-7692	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972580181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANE TALLO M.D.

Provider Business Mailing Address
First Line	:	500 THOMAS LN
Second Line	:	SUITE 3-G
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1419
Country	:	US
Telephone Number	:	614-457-7732
Fax Number	:	614-457-4346

Provider Business Practice Location Address
First Line	:	500 THOMAS LN
Second Line	:	SUITE 3-G
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1419
Country	:	US
Telephone Number	:	614-457-7732
Fax Number	:	614-457-4346

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

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	03/16/2011

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Directions to “ DIANE TALLO M.D.” Practice Location

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