Provider Demographics
NPI:1053347377
Name:ICHIKAWA, DIANE CL (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:CL
Last Name:ICHIKAWA
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 1:850 CLAIRTON BLVD
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-4567
Mailing Address - Country:US
Mailing Address - Phone:412-466-2222
Mailing Address - Fax:412-466-4668
Practice Address - Street 1:850 CLAIRTON BLVD
Practice Address - Street 2:SUITE 3100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-4567
Practice Address - Country:US
Practice Address - Phone:412-466-2222
Practice Address - Fax:412-466-4668
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025646E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA193673KH3Medicare ID - Type Unspecified
PAB41037Medicare UPIN