Provider Demographics
NPI:1740269810
Name:DIAMOND, THOMAS E (CRNA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 KITCHNER CT
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-1829
Mailing Address - Country:US
Mailing Address - Phone:919-383-5847
Mailing Address - Fax:
Practice Address - Street 1:31 KITCHNER CT
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-1829
Practice Address - Country:US
Practice Address - Phone:919-383-5847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC046387367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0264UOtherBCBS
NC16186OtherPARTNERS
NC2210844OtherUHC
NC8051435Medicaid
NC2210844OtherUHC
NC8051435Medicaid