Provider Demographics
NPI:1194774133
Name:DIAMOND, NICHOLAS P (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:P
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:426 S MILTON DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3466
Mailing Address - Country:US
Mailing Address - Phone:215-782-8760
Mailing Address - Fax:215-635-7130
Practice Address - Street 1:8080 OLD YORK RD
Practice Address - Street 2:SUITE 208
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1421
Practice Address - Country:US
Practice Address - Phone:215-782-8760
Practice Address - Fax:215-635-7130
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006732E2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA465635Medicare ID - Type Unspecified
PAE79106Medicare UPIN