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General NPI Number Information
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NPI Number | 1386608339
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Entity Type | Individual
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Provider Name | NITA K DIVAN MD
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Gender | Female
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Dates
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Enumeration Date | 04/14/2006
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Last Update Date | 12/19/2009
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Provider Practice Location Address
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Address Line | 1150 YOUNGS RD SUITE 203
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-8053
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Country | US
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Telephone | 716-688-7344
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Fax | 716-688-7345
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Provider Business Mailing Address
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Address Line | PO BOX 1528
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City | WILLIAMSVILLE
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State | NY
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Zip | 14231-1528
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Country | US
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Telephone | 716-688-7344
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Fax | 716-688-7345
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200884
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License Number State | NY
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