Basic Information
| Provider Information | |||||||||
| NPI: | 1578539771 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HURSH | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1735 27TH ST STE B06 | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456622681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403568681 | ||||||||
| FaxNumber: | 7403537900 | ||||||||
| Practice Location | |||||||||
| Address1: | 1805 27TH ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456622640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403568231 | ||||||||
| FaxNumber: | 7403563686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 12/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 29819 | KY | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 35.087125 | OH | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0226535 | 05 | OH | MEDICAID | 2001241000 | 05 | WV | MEDICAID | P00305897 | 01 | VA | RAILROAD MEDICARE | OTHER | 64298193 | 05 | KY | MEDICAID | 010237637 | 05 | VA | MEDICAID | P00681730 | 01 | KY | RAILROAD MEDICARE | OTHER | 64298183 | 05 | KY | MEDICAID | 145987 | 01 | VA | ANTHEM BLUE CROSS | OTHER |