Individual
DR. DIANA RENEE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7900 TURIN ROAD, BUILDING 4, SUITE 2, ROME, NY 13440-7423
(315) 338-7284
(315) 338-7286
Mailing address
7900 TURIN ROAD, BUILDING 4, SUITE 2, ROME, NY 13440-7423
(315) 338-7284
(315) 338-7286
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
255422
NY
207V00000X
Obstetrics & Gynecology Physician
MD 2015-0031
NM
207V00000X
Obstetrics & Gynecology Physician
MD 433457
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118476
GEISINGER HEALTH PLAN
PA
01
—
1572573
GATEWAY-WMG
PA
01
—
20076171
AMERIHEALTH MERCY-WMG
PA
01
—
2039121
HIGHMARK BLUE SHIELD
PA
01
—
212422
JOHNS HOPKINS
PA
01
—
50077199
CAPITAL BLUE CROSS-WMG
PA
01
—
92199182
AETNA
PA
01
—
932354
CAREFIRST MD BCBS
MD
Enumeration date
07/31/2006
Last updated
11/05/2015
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