Provider Demographics
NPI:1538333430
Name:PIECORO, DAVA WEST (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVA
Middle Name:WEST
Last Name:PIECORO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAVA
Other - Middle Name:SUSANNE
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 ROSE ST # MS 117
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0298
Mailing Address - Country:US
Mailing Address - Phone:859-323-5425
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST # MS 117
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0298
Practice Address - Country:US
Practice Address - Phone:859-323-5425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45441207ZC0500X, 207ZH0000X, 207ZP0102X, 207ZC0500X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100245010Medicaid
KYK088041Medicare PIN