Provider Demographics
NPI:1609834878
Name:MANOS, DIANE C (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:C
Last Name:MANOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:660 ACKERMAN
Mailing Address - Street 2:3RD FLOOR PO BOX 183103
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-3108
Mailing Address - Country:US
Mailing Address - Phone:614-293-2150
Mailing Address - Fax:614-293-6479
Practice Address - Street 1:2000 KENNY ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221
Practice Address - Country:US
Practice Address - Phone:614-293-9777
Practice Address - Fax:614-293-9776
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35057320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0907273Medicaid
E95963Medicare UPIN
OH0907273Medicaid