Provider Demographics
NPI:1861618043
Name:DIAMANTI, THEODHOR (MD)
Entity type:Individual
Prefix:MR
First Name:THEODHOR
Middle Name:
Last Name:DIAMANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:THEODHOR
Other - Middle Name:
Other - Last Name:DHJAMANTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:51 N. 39TH STREET
Mailing Address - Street 2:PHI - 2C
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-9010
Mailing Address - Fax:215-662-9733
Practice Address - Street 1:51 N. 39TH STREET
Practice Address - Street 2:PHI - 2C
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-662-9010
Practice Address - Fax:215-662-9733
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36114346207R00000X
PAMD434652207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine