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General NPI Number Information
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NPI Number | 1144214958
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Entity Type | Individual
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Provider Name | ASHUTOSH B DIWAN MD
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Gender | Male
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 493 BLACKWELL RD SUITE 202
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City | WARRENTON
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State | VA
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Zip | 20186-2639
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Country | US
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Telephone | 540-347-4400
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Fax | 540-341-4766
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Provider Business Mailing Address
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Address Line | PO BOX 748613
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City | ATLANTA
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State | GA
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Zip | 30384-8613
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Country | US
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Telephone | 434-295-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 2023001690
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101229792
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0429558
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License Number State | KS
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