Provider Demographics
NPI:1568456960
Name:PELTO, DIANE H (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:H
Last Name:PELTO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3260
Mailing Address - Country:US
Mailing Address - Phone:719-434-7019
Mailing Address - Fax:719-487-0005
Practice Address - Street 1:4 OAK AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3260
Practice Address - Country:US
Practice Address - Phone:719-434-7019
Practice Address - Fax:719-487-0005
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0035998207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO050050074OtherRAILROAD MEDICARE NUMBER
CO01359983Medicaid
COCL9858Medicare PIN
CO01359983Medicaid