Provider Demographics
NPI:1790113660
Name:DIAMOND, TOVA M (PA-C)
Entity Type:Individual
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First Name:TOVA
Middle Name:M
Last Name:DIAMOND
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:217 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HADDON HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:08035-1703
Practice Address - Country:US
Practice Address - Phone:856-547-1212
Practice Address - Fax:856-547-3722
Is Sole Proprietor?:No
Enumeration Date:2013-10-31
Last Update Date:2020-10-28
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Provider Licenses
StateLicense IDTaxonomies
PAMA056466363A00000X
NJ25MP00319500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant