Provider Demographics
NPI:1982656286
Name:PAGE, DIANA L (DO)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:L
Last Name:PAGE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:L
Other - Last Name:SASSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:624 MCCLELLAN ST
Mailing Address - Street 2:SUITE G01
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-1020
Mailing Address - Country:US
Mailing Address - Phone:518-347-5655
Mailing Address - Fax:518-347-5656
Practice Address - Street 1:624 MCCLELLAN ST
Practice Address - Street 2:SUITE G01
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1020
Practice Address - Country:US
Practice Address - Phone:518-347-5655
Practice Address - Fax:518-347-5656
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256273207YX0905X
NJ25MB08359600207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03220468Medicaid
NY03220468Medicaid