Provider Demographics
NPI:1457435976
Name:FALKOWITZ, DIANNA C (MD)
Entity type:Individual
Prefix:
First Name:DIANNA
Middle Name:C
Last Name:FALKOWITZ
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 1:2821 ISLAND AVE
Mailing Address - Street 2:SUITE 131
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-2300
Mailing Address - Country:US
Mailing Address - Phone:215-863-6171
Mailing Address - Fax:215-863-2364
Practice Address - Street 1:2821 ISLAND AVE
Practice Address - Street 2:SUITE 131
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-2300
Practice Address - Country:US
Practice Address - Phone:215-863-6171
Practice Address - Fax:215-863-2364
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07332900207RN0300X
PAMD055632L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA168360000Medicaid
PA952740V7RMedicare PIN