Provider Demographics
NPI:1083935282
Name:RAUB, DIANA M (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:RAUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:M
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20397 ROUTE 19 STE 330
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6133
Mailing Address - Country:US
Mailing Address - Phone:724-772-3300
Mailing Address - Fax:724-772-3360
Practice Address - Street 1:20397 ROUTE 19 STE 330
Practice Address - Street 2:
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6133
Practice Address - Country:US
Practice Address - Phone:724-772-3300
Practice Address - Fax:724-772-3360
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016674207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102847441Medicaid