Provider Demographics
NPI:1457670234
Name:TYLER ROCKS, DIANA MARIE (DO)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:MARIE
Last Name:TYLER ROCKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 COMPUTER AVENUE, STE M69
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1745
Mailing Address - Country:US
Mailing Address - Phone:215-346-2821
Mailing Address - Fax:215-346-2823
Practice Address - Street 1:2300 COMPUTER AVENUE, STE M69
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090
Practice Address - Country:US
Practice Address - Phone:215-346-2821
Practice Address - Fax:215-346-2823
Is Sole Proprietor?:No
Enumeration Date:2010-05-19
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015939207R00000X
PAOT013224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine