Provider Demographics
NPI:1477793750
Name:DUTRA, DIANA DAWN (DO)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:DAWN
Last Name:DUTRA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:100 NORTH ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-214-5681
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:210 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:PA
Practice Address - Zip Code:16866-5500
Practice Address - Country:US
Practice Address - Phone:814-342-5402
Practice Address - Fax:814-342-0598
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS016007208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics