MEDICARE: DR. DIANA LOIS MRVOS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD030339E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD030339E	OTHER	PA	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1134349905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANA LOIS MRVOS M.D.

Provider Business Mailing Address
First Line	:	400 FAIRVIEW RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-1908
Country	:	US
Telephone Number	:	412-963-1879
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 FAIRVIEW RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15238-1908
Country	:	US
Telephone Number	:	412-963-1879
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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