Provider Demographics
NPI:1033463401
Name:DIAMOND, CAROLE M (MD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:M
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 278
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL BAY
Mailing Address - State:NV
Mailing Address - Zip Code:89402
Mailing Address - Country:US
Mailing Address - Phone:775-832-5242
Mailing Address - Fax:
Practice Address - Street 1:344 WASSOU RD
Practice Address - Street 2:
Practice Address - City:CRYSTAL BAY
Practice Address - State:NV
Practice Address - Zip Code:89402
Practice Address - Country:US
Practice Address - Phone:775-832-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG254-01208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
A90938Medicare UPIN