Provider Demographics
NPI:1528132610
Name:STEPHEN DIAMANTONI & ASSOCIATES FAMILY PRACTICE PC
Entity type:Organization
Organization Name:STEPHEN DIAMANTONI & ASSOCIATES FAMILY PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIAMANTONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-295-2323
Mailing Address - Street 1:734 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2176
Mailing Address - Country:US
Mailing Address - Phone:717-295-2323
Mailing Address - Fax:717-295-7294
Practice Address - Street 1:734 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2176
Practice Address - Country:US
Practice Address - Phone:717-295-7109
Practice Address - Fax:717-295-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029374E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007677260004Medicaid
PA1007677260004Medicaid
PA158841Medicare ID - Type UnspecifiedGROUP NUMBER
158841Medicare PIN