Provider Demographics
NPI:1376809988
Name:BARROS, DIANE LEIGH PAZ (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:LEIGH PAZ
Last Name:BARROS
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 1:2955 IVY RD STE 205
Mailing Address - Street 2:BOX 801205
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-1205
Mailing Address - Country:US
Mailing Address - Phone:434-243-4500
Mailing Address - Fax:434-293-8570
Practice Address - Street 1:2955 IVY RD STE 205
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-1205
Practice Address - Country:US
Practice Address - Phone:434-243-4500
Practice Address - Fax:434-293-8570
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101257706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4892231OtherAETNA