Provider Demographics
NPI:1699779561
Name:CAVANAH, DIANA K (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:K
Last Name:CAVANAH
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 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1759
Mailing Address - Country:US
Mailing Address - Phone:270-781-5111
Mailing Address - Fax:270-780-0467
Practice Address - Street 1:201 PARK ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1759
Practice Address - Country:US
Practice Address - Phone:270-781-5111
Practice Address - Fax:270-780-0467
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27975207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50006876OtherPASSPORT
KY000000044752OtherANTHEM
KY30001514OtherRAILROAD MEDICARE
KY64279755Medicaid
KY30001514OtherRAILROAD MEDICARE
KY64279755Medicaid
KYE44361Medicare UPIN
KY1524301Medicare PIN