Provider Demographics
NPI:1871577098
Name:DIAZ, GLORIA JANET (MD)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:JANET
Last Name:DIAZ
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 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-3008
Mailing Address - Fax:215-707-1387
Practice Address - Street 1:2301 E ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4427
Practice Address - Country:US
Practice Address - Phone:215-926-3700
Practice Address - Fax:215-926-3702
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053874L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001597753Medicaid
PA160032946OtherRAILROAD MEDICARE
PA885573OtherHIGHMARK BLUE SHIELD
PA1041943OtherKMHP
PA519064OtherCOVENTRY HEALTH AMERICA
PA0013242000OtherINDEPENDENCE BLUE CROSS
PA0581982OtherAETNA HMO
PA2013029OtherUNITED HEALTHCARE
PACD4829OtherRAILROAD MEDICARE GROUP TPI
PA0159775307OtherAMERICHOICE
PA597586OtherMEDICARE GROUP TPI
PA2891OtherBRAVO HEALTH
PA2Y3095OtherHEALTH NET
PA5723452OtherAETNA PPO
PAP416865OtherOXFORD
PA0581982OtherAETNA HMO
PACD4829OtherRAILROAD MEDICARE GROUP TPI