MEDICARE: DIA P OWENS MD

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	207Q00000X	Family Medicine Physician	0101236978	VA

General Provider Information

NPI Number	:	1154392025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIA P OWENS MD

Provider Business Mailing Address
First Line	:	602 W MORGAN AVE
Second Line	:	SUITE 3
City	:	PENNINGTON GAP
State	:	VA
Zip	:	24277-2036
Country	:	US
Telephone Number	:	276-546-5310
Fax Number	:	276-546-5469

Provider Business Practice Location Address
First Line	:	602 W MORGAN AVE
Second Line	:	SUITE 3
City	:	PENNINGTON GAP
State	:	VA
Zip	:	24277-2036
Country	:	US
Telephone Number	:	276-546-5310
Fax Number	:

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	01/19/2011

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