Provider Demographics
NPI:1962617837
Name:DIAMOND, MARY ELIZABETH (DO)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 PAOLI PLZ
Mailing Address - Street 2:SUITE D1
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1367
Mailing Address - Country:US
Mailing Address - Phone:610-296-9238
Mailing Address - Fax:610-296-9239
Practice Address - Street 1:41 PAOLI PLZ
Practice Address - Street 2:SUITE D1
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1367
Practice Address - Country:US
Practice Address - Phone:610-296-9238
Practice Address - Fax:610-296-9239
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008869L2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry