Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 35-090913 | OH |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD034843 | DC |
N | 208200000X | Surgeon | 35.090913 | OH |
N | 208600000X | Surgeon | 35.090913 | OH |
NPI | 1245338128 |
---|---|
Provider Name | Dr. Diana Chuong Ponsky |
First Address | Euclid, OH 44117-1714 |
Second Address | Cleveland, OH 44106-1716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 14/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1022531320001 | (05) | PA |
2884115 | (05) | OH |
P00682018 | RAILROAD MEDICARE (01) | OH |