Provider Demographics
NPI:1679576771
Name:DIAS, DARRYL D (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:D
Last Name:DIAS
Suffix:
Gender:M
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-331-0774
Mailing Address - Fax:859-578-3800
Practice Address - Street 1:711 MEDICAL VILLAGE DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-331-0774
Practice Address - Fax:859-578-3800
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070816A207RC0000X
KY36524207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50024713Medicaid
IN200501320Medicaid
OH2528536Medicaid
KY64083116Medicaid
KYP00920125OtherRR MEDICARE
KY00954018Medicare PIN
KY64083116Medicaid
KY0551826Medicare PIN
INM400070275Medicare PIN
KYP00114458Medicare PIN
KYP400041722Medicare PIN