Provider Demographics
NPI:1952416802
Name:DIAZ, ALBERTO NOEL (MD)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:NOEL
Last Name:DIAZ
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 1:125 E BROAD ST STE 305
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6447
Mailing Address - Country:US
Mailing Address - Phone:440-414-9100
Mailing Address - Fax:216-201-5578
Practice Address - Street 1:125 E BROAD ST
Practice Address - Street 2:SUITE 305
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6400
Practice Address - Country:US
Practice Address - Phone:440-414-9100
Practice Address - Fax:216-201-5578
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086764207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2586509Medicaid
OH2586509Medicaid
OHI43863Medicare UPIN