Provider Demographics
NPI:1841262656
Name:CARMONA, DIANA PATRICIA (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:PATRICIA
Last Name:CARMONA
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 1:651 COLLIERS WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5058
Mailing Address - Country:US
Mailing Address - Phone:304-797-6535
Mailing Address - Fax:
Practice Address - Street 1:651 COLLIERS WAY STE 201
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5055
Practice Address - Country:US
Practice Address - Phone:304-723-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.097928207VX0201X
PAMD071348L207VX0201X
WV26118207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
6069944OtherCIGNA PIN
1996750OtherUNITED HEALTH CARE PIN
PA1530814OtherGATEWAY HEALTH PLAN PIN
PA1753100OtherHIGHMARK BC/BS PIN
212080OtherUPMC HEALTH PLAN PIN
264138OtherCOVENTRY HEALTH CARE PIN
7767534OtherAETNA PROVIDER ID
7767534OtherAETNA PROVIDER ID
PA1530814OtherGATEWAY HEALTH PLAN PIN
PA1753100OtherHIGHMARK BC/BS PIN
PA20-2703593OtherTAX ID NUMBER