Provider Demographics
NPI:1386637114
Name:DIAMOND, STEPHANIE P (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:P
Last Name:DIAMOND
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 1:2201 FOREST HILLS DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1089
Mailing Address - Country:US
Mailing Address - Phone:717-652-5063
Mailing Address - Fax:717-671-9554
Practice Address - Street 1:2201 FOREST HILLS DR
Practice Address - Street 2:SUITE 7
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1089
Practice Address - Country:US
Practice Address - Phone:717-652-5063
Practice Address - Fax:717-671-9554
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049642L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02882300OtherCAPITAL BLUE CROSS
PA742771OtherHIGHMARK BLUE SHIELD
PA02882300OtherCAPITAL BLUE CROSS
PA742771Medicare ID - Type Unspecified