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General NPI Number Information
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NPI Number | 1730261132
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Entity Type | Individual
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Provider Name | DIANA MARILYN GAVIRIA MD
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Gender | Female
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 07/08/2025
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Provider Practice Location Address
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Address Line | 800 EMMETT ROUSCH DR
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City | MARTINSBURG
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State | WV
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Zip | 25401-6313
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Country | US
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Telephone | 304-263-5131
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Fax | 304-263-1067
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Provider Business Mailing Address
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Address Line | 800 EMMETT ROUSCH DR
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City | MARTINSBURG
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State | WV
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Zip | 25401-6313
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Country | US
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Telephone | 304-263-5131
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Fax | 304-263-1067
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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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 17550
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License Number State | WV
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