Provider Demographics
NPI:1164604641
Name:ROBERT ANDREW DIAMOND
Entity Type:Organization
Organization Name:ROBERT ANDREW DIAMOND
Other - Org Name:ROBERT A DIAMOND DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIAMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:610-865-0311
Mailing Address - Street 1:303 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5526
Mailing Address - Country:US
Mailing Address - Phone:610-865-0311
Mailing Address - Fax:610-865-9458
Practice Address - Street 1:303 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5526
Practice Address - Country:US
Practice Address - Phone:610-865-0311
Practice Address - Fax:610-865-9458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002298L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0639260001Medicare NSC