Provider Demographics
NPI:1225039530
Name:PERAZZO, DIANNA HULL (MD)
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:HULL
Last Name:PERAZZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636324
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6324
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:1 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-3403
Practice Address - Country:US
Practice Address - Phone:859-301-5705
Practice Address - Fax:859-301-2022
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30950207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2352252Medicaid
KY64055692Medicaid
IN200916710Medicaid
IN200916710Medicaid
KY3313202Medicare PIN
KY0655084Medicare PIN
KYH14626Medicare UPIN
OH2352252Medicaid