Provider Demographics
NPI:1912081019
Name:DIAMOND, MARK PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PHILIP
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:925 DROHOMER PLACE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210
Mailing Address - Country:US
Mailing Address - Phone:410-435-2933
Mailing Address - Fax:410-574-5879
Practice Address - Street 1:9105 FRANKLIN SQUARE DRIVE
Practice Address - Street 2:SUITE 308
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-574-5877
Practice Address - Fax:410-574-5879
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2789Medicare ID - Type Unspecified
D73762Medicare UPIN