Provider Demographics
NPI:1407207350
Name:CORBIN, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CORBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 ECHO DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-8994
Mailing Address - Country:US
Mailing Address - Phone:740-973-4168
Mailing Address - Fax:
Practice Address - Street 1:316 ECHO DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-8994
Practice Address - Country:US
Practice Address - Phone:740-973-4168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2548836Medicaid