Provider Demographics
NPI:1750328902
Name:TREABA, DIANA OLGUTA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:OLGUTA
Last Name:TREABA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 EDDY ST
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY APC-12
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4923
Mailing Address - Country:US
Mailing Address - Phone:401-793-4247
Mailing Address - Fax:401-274-5154
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY APC-12
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-793-4247
Practice Address - Fax:401-274-5154
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11989207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7058359Medicaid
RII50063Medicare UPIN