Healthcare Provider Details

I. General information

NPI: 1346250925
Provider Name (Legal Business Name): DIANE M MRAVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13700 ST. FRANCIS BLVD SUITE 305
MIDLOTHIAN VA
23114-3222
US

IV. Provider business mailing address

13700 ST. FRANCIS BLVD SUITE 305
MIDLOTHIAN VA
23114-3222
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-2483
  • Fax: 804-419-1860
Mailing address:
  • Phone: 804-320-2483
  • Fax: 804-419-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101055659
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: