Provider Demographics
NPI:1518954676
Name:GRANESE, DIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:GRANESE
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 1:720 2ND AVE
Mailing Address - Street 2:303
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1778
Mailing Address - Country:US
Mailing Address - Phone:270-781-5111
Mailing Address - Fax:270-780-0478
Practice Address - Street 1:720 2ND AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1778
Practice Address - Country:US
Practice Address - Phone:270-781-5111
Practice Address - Fax:270-780-0478
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25009207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000049407OtherBCBS
KY64250095Medicaid
KY64250095Medicaid
1448401Medicare PIN