Provider Demographics
NPI:1740250018
Name:DINERMAN, JAY LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:LAWRENCE
Last Name:DINERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4312
Mailing Address - Country:US
Mailing Address - Phone:256-539-4080
Mailing Address - Fax:256-539-4099
Practice Address - Street 1:930 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4312
Practice Address - Country:US
Practice Address - Phone:256-539-4080
Practice Address - Fax:256-539-4099
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23742207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL112284Medicaid
AL112292Medicaid
AL510-49220OtherBCBS
AL051500185Medicaid
TN3335705Medicaid
AL515-99674OtherBCBS
P00747425OtherRAILROAD MEDICARE
060061475OtherRAILROAD MEDICARE
TN4011927OtherBCBS
AL51000185OtherBCBS
AL112282Medicaid
AL112287Medicaid
AL510-49219OtherBCBS
AL515-99672OtherBCBS
AL515-99673OtherBCBS
25-00014OtherUNITED HEALTHCARE
4583857OtherAETNA
AL510-49218OtherBCBS
AL112290Medicaid
AL112295Medicaid
060061475OtherRAILROAD MEDICARE
AL515-99674OtherBCBS
AL112287Medicaid
AL102I064076Medicare PIN