Provider Demographics
NPI:1245338128
Name:PONSKY, DIANA CHUONG (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:CHUONG
Last Name:PONSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:CHUONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:DEPT OF OTOLARYNGOLOGY
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-544-8684
Practice Address - Fax:216-229-7969
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-090913207YX0905X
DCMD034843207YX0905X
OH35.090913208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1022531320001Medicaid
OH2884115Medicaid
OHP00682018OtherRAILROAD MEDICARE
OHPO4250631Medicare PIN