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NPI Code Detail

MEDICARE: DIANA L WOLAN MD

MEDICARE: DIANA L WOLAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician0101037199VA

General Provider Information

NPI Number : 1073553814
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA L WOLAN MD
Provider Business Mailing Address
First Line : 3241 WESTERN BRANCH BLVD
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23321-5260
Country : US
Telephone Number : 757-686-3508
Fax Number : 757-686-0541
Provider Business Practice Location Address
First Line : 7924 CHESAPEAKE BLVD
Second Line :
City : NORFOLK
State : VA
Zip : 23518-3801
Country : US
Telephone Number : 757-587-1700
Fax Number : 757-480-1295
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 04/09/2010

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Directions to “ DIANA L WOLAN MD” Practice Location

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