Provider Demographics
NPI:1093165540
Name:TACELOSKY, DIANA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:TACELOSKY
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 UNIVERSITY DRIVE MC CA 410
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-2360
Mailing Address - Country:US
Mailing Address - Phone:717-531-5208
Mailing Address - Fax:717-531-0119
Practice Address - Street 1:1 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-2231
Practice Address - Country:US
Practice Address - Phone:717-531-5164
Practice Address - Fax:717-531-0646
Is Sole Proprietor?:No
Enumeration Date:2016-06-15
Last Update Date:2023-08-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0116029131207Q00000X
PAMT219722207Q00000X
PAMD482087207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine