Healthcare Provider Details

I. General information

NPI: 1154392025
Provider Name (Legal Business Name): DIA P OWENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 W MORGAN AVE SUITE 3
PENNINGTON GAP VA
24277-2036
US

IV. Provider business mailing address

602 W MORGAN AVE SUITE 3
PENNINGTON GAP VA
24277-2036
US

V. Phone/Fax

Practice location:
  • Phone: 276-546-5310
  • Fax:
Mailing address:
  • Phone: 276-546-5310
  • Fax: 276-546-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101236978
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: