Provider Demographics
NPI:1669463915
Name:CLAVIN, DIANA K (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:K
Last Name:CLAVIN
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 1:1150 ROBERT BLVD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2004
Mailing Address - Country:US
Mailing Address - Phone:985-781-4848
Mailing Address - Fax:985-781-4850
Practice Address - Street 1:1150 ROBERT BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2004
Practice Address - Country:US
Practice Address - Phone:985-781-4848
Practice Address - Fax:985-781-4850
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA20824207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02550870Medicaid
160045156OtherRAILROAD MEDICARE
LA1980935Medicaid
MS$$$$$$$$$COtherBCBS LA PROVIDER NUMBER
LA1980935Medicaid
G29390Medicare UPIN
LA5W897Medicare PIN
LA5W897DS23Medicare PIN