Provider Demographics
NPI:1831195445
Name:DIAMOND, ELLIOT (DPM)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 CHESTNUT STREET
Mailing Address - Street 2:STE 201
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3051
Mailing Address - Country:US
Mailing Address - Phone:215-923-2455
Mailing Address - Fax:215-923-4535
Practice Address - Street 1:123 CHESTNUT ST STE 201
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-3051
Practice Address - Country:US
Practice Address - Phone:215-923-2455
Practice Address - Fax:215-923-4535
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002164L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
D11537095OtherB.S.
PA000710450Medicaid
PA000710450Medicaid
PA165687Medicare PIN