Basic Information
| Provider Information | |||||||||
| NPI: | 1740250018 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DINERMAN | ||||||||
| FirstName: | JAY | ||||||||
| MiddleName: | LAWRENCE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2006 | ||||||||
| LastUpdateDate: | 04/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 23742 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 23742 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 112284 | 05 | AL | MEDICAID | 112292 | 05 | AL | MEDICAID | 510-49220 | 01 | AL | BCBS | OTHER | 051500185 | 05 | AL | MEDICAID | 3335705 | 05 | TN | MEDICAID | 515-99674 | 01 | AL | BCBS | OTHER | P00747425 | 01 | RAILROAD MEDICARE | OTHER | 060061475 | 01 | RAILROAD MEDICARE | OTHER | 4011927 | 01 | TN | BCBS | OTHER | 51000185 | 01 | AL | BCBS | OTHER | 112282 | 05 | AL | MEDICAID | 112287 | 05 | AL | MEDICAID | 510-49219 | 01 | AL | BCBS | OTHER | 515-99672 | 01 | AL | BCBS | OTHER | 515-99673 | 01 | AL | BCBS | OTHER | 25-00014 | 01 | UNITED HEALTHCARE | OTHER | 4583857 | 01 | AETNA | OTHER | 510-49218 | 01 | AL | BCBS | OTHER | 112290 | 05 | AL | MEDICAID | 112295 | 05 | AL | MEDICAID |