Provider Demographics
NPI:1689701229
Name:KAMENETSKY, DIANNE C (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:C
Last Name:KAMENETSKY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 34120
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4120
Mailing Address - Country:US
Mailing Address - Phone:775-747-5050
Mailing Address - Fax:775-747-5005
Practice Address - Street 1:10870 BROCKWAY RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-2054
Practice Address - Country:US
Practice Address - Phone:530-550-0440
Practice Address - Fax:530-582-8853
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2012-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG75315207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF74283Medicare UPIN