Provider Demographics
NPI:1194726018
Name:ZITTER, DIANA M (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:M
Last Name:ZITTER
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 1:4333 HAYES RD
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9269
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4461 S. BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-3990
Practice Address - Country:US
Practice Address - Phone:614-875-0444
Practice Address - Fax:614-875-1193
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046347174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0558927Medicaid
OH9364211Medicare PIN
OH0558927Medicaid
OHZI0574221Medicare ID - Type Unspecified