Provider Demographics
NPI:1063471662
Name:TOLEN, DIANNA L (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANNA
Middle Name:L
Last Name:TOLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4133 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9047
Mailing Address - Country:US
Mailing Address - Phone:330-702-5437
Mailing Address - Fax:330-702-8684
Practice Address - Street 1:4133 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1527
Practice Address - Country:US
Practice Address - Phone:330-702-5437
Practice Address - Fax:330-702-8684
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-1315-T208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2056206Medicaid
OHH07724Medicare UPIN