Provider Demographics
NPI:1982962189
Name:MAGAS, DIANE MELYNNE
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:MELYNNE
Last Name:MAGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 MAYLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1262
Mailing Address - Country:US
Mailing Address - Phone:330-606-8839
Mailing Address - Fax:
Practice Address - Street 1:274 MAYLAWN AVE
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1262
Practice Address - Country:US
Practice Address - Phone:330-606-8839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist