Provider Demographics
NPI:1184628869
Name:DONATI, DIANA M (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:M
Last Name:DONATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:M
Other - Last Name:FREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:770 JASONWAY AVE
Mailing Address - Street 2:SUITE G-2
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-4333
Mailing Address - Country:US
Mailing Address - Phone:614-459-4675
Mailing Address - Fax:614-459-4675
Practice Address - Street 1:770 JASONWAY AVE
Practice Address - Street 2:SUITE G-2
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-4333
Practice Address - Country:US
Practice Address - Phone:614-459-4675
Practice Address - Fax:614-459-4675
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35077599207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2177031Medicaid
OH2177031Medicaid
OHH16169Medicare UPIN