Provider Demographics
NPI:1396723136
Name:KANE, DIANE (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:KANE
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 1:1500 PORTLAND AVENUE
Mailing Address - Street 2:ST ANNS COMMUNITY
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-697-6413
Mailing Address - Fax:585-342-9166
Practice Address - Street 1:1500 PORTLAND AVENUE
Practice Address - Street 2:ST ANNS COMMUNITY
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-697-6413
Practice Address - Fax:585-342-9166
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1703411207R00000X
NY170341-1207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P010170341OtherBLUE CHOICE
102536BJOtherPREFERRED CARE
P030170341OtherBLUE SHIELD HERITAGE
P040170341OtherSACMP
P020170341OtherBLUE SHIELD ST ANNS
B81041Medicare ID - Type UnspecifiedHERITAGE
P030170341OtherBLUE SHIELD HERITAGE
P040170341OtherSACMP