Provider Demographics
NPI:1154305753
Name:RADFORD, DIANE M (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:RADFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9500 EUCLID AVE
Mailing Address - Street 2:A80
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-7506
Mailing Address - Fax:216-445-4048
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:A80
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-7506
Practice Address - Fax:216-445-4048
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1276562086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203011325Medicaid
MO203011325Medicaid
MOE79155Medicare UPIN