Provider Demographics
NPI:1083693477
Name:GREENE-CHANDOS, DIANA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:LYNN
Last Name:GREENE-CHANDOS
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 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-685-6917
Mailing Address - Fax:614-366-7004
Practice Address - Street 1:410 W 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1240
Practice Address - Country:US
Practice Address - Phone:614-293-8714
Practice Address - Fax:614-293-4281
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0958852084N0600X, 2084V0102X
NMMD2019-01902084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3110556Medicaid
OHP01686423OtherRAILROAD MEDICARE
OHP01686423OtherRAILROAD MEDICARE