Provider Demographics
NPI:1346250925
Name:MRAVA, DIANE M (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:MRAVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13700 ST. FRANCIS BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3222
Mailing Address - Country:US
Mailing Address - Phone:804-320-2483
Mailing Address - Fax:804-419-1860
Practice Address - Street 1:13700 ST. FRANCIS BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3222
Practice Address - Country:US
Practice Address - Phone:804-320-2483
Practice Address - Fax:804-419-1860
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101055659207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6216935Medicaid
C09633OtherGROUP PTAN
VA000325087Medicare PIN
VAH31758Medicare UPIN