Healthcare Provider Details

I. General information

NPI: 1730261132
Provider Name (Legal Business Name): DIANA MARILYN GAVIRIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 EMMETT ROUSCH DR
MARTINSBURG WV
25401-6313
US

IV. Provider business mailing address

800 EMMETT ROUSCH DR
MARTINSBURG WV
25401-6313
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-5131
  • Fax: 304-263-1067
Mailing address:
  • Phone: 304-263-5131
  • Fax: 304-263-1067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number17550
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: