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General NPI Number Information
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NPI Number | 1275799181
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Entity Type | Individual
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Provider Name | VIRGINIA MARIA DIAVOLITSIS MD
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Gender | Female
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 300 W 10TH AVE ROOM 86
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City | COLUMBUS
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State | OH
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Zip | 43210-1280
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Country | US
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Telephone | 614-366-3886
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Fax |
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Provider Business Mailing Address
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Address Line | 300 W 10TH AVE ROOM 86
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City | COLUMBUS
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State | OH
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Zip | 43210-1280
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Country | US
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Telephone |
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | AN5240394-3761
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 35.097820
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License Number State | OH
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