Individual
DR. CLARISSA JONAS DIAMANTIDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-1544
(336) 713-4156
(336) 716-4359
Mailing address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 713-4156
(336) 716-7359
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2014-01223
NC
207RN0300X
Nephrology Physician
D70807
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
510360600
—
MD
01
—
965568-01 & 02
CAREFIRST BC/BS
MD
01
—
S062-0394
CAREFIRST BC/BS REGIONAL
MD
Enumeration date
06/20/2007
Last updated
03/13/2024
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