Provider Demographics
NPI:1831240100
Name:DIAMANTONI, STEPHEN G (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:G
Last Name:DIAMANTONI
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 1:734 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2176
Mailing Address - Country:US
Mailing Address - Phone:717-295-2323
Mailing Address - Fax:717-295-7294
Practice Address - Street 1:734 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2176
Practice Address - Country:US
Practice Address - Phone:717-295-2323
Practice Address - Fax:717-295-7294
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029374E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009958720001Medicaid
PA158841OtherMEDICARE GROUP NUMBER
PA0009958720001Medicaid