Provider Demographics
NPI:1316053952
Name:DIAMOND, RICHARD MARC (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARC
Last Name:DIAMOND
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 1:164 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:CORNWALL
Mailing Address - State:NY
Mailing Address - Zip Code:12518-1329
Mailing Address - Country:US
Mailing Address - Phone:845-534-3888
Mailing Address - Fax:845-534-4208
Practice Address - Street 1:164 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:NY
Practice Address - Zip Code:12518-1329
Practice Address - Country:US
Practice Address - Phone:845-534-3888
Practice Address - Fax:845-534-4208
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136654207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00913855Medicaid
NY79A871Medicare ID - Type Unspecified
NYB79501Medicare UPIN