Provider Demographics
NPI:1295793735
Name:TAYLOR, DIANA LEE (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L-3652
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:740-383-7927
Mailing Address - Fax:740-383-7942
Practice Address - Street 1:6 LEXINGTON BLVD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1047
Practice Address - Country:US
Practice Address - Phone:740-363-3309
Practice Address - Fax:740-383-7942
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.063669207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000118410OtherANTHEM
OH0968770Medicaid
637439OtherAETNA
0102121OtherUHC
0726913OtherPALMETTO
353077OtherSUBMITTER NUMBER
0102121OtherUHC
080054559Medicare ID - Type UnspecifiedTRAVELERS
OHH160700Medicare PIN
311098079048OtherCIGNA
637439OtherAETNA
080054559Medicare ID - Type UnspecifiedTRAVELERS
F40630Medicare UPIN
OH0968770Medicaid