Provider Demographics
NPI:1578539433
Name:DIAMOND, JONATHAN R (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:R
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-0517
Mailing Address - Country:US
Mailing Address - Phone:570-450-6200
Mailing Address - Fax:570-450-6207
Practice Address - Street 1:4700 UNION DEPOSIT RD
Practice Address - Street 2:SUITE 240
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17111-3774
Practice Address - Country:US
Practice Address - Phone:717-526-4474
Practice Address - Fax:717-526-4476
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD043430E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB74662Medicare UPIN
PA429579MC6Medicare PIN