Provider Demographics
NPI:1619920246
Name:DIOKNO, VICTORIA M (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:M
Last Name:DIOKNO
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 1:100 FAIR SAILING RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8158
Mailing Address - Country:US
Mailing Address - Phone:843-972-7873
Mailing Address - Fax:
Practice Address - Street 1:100 FAIR SAILING RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-8158
Practice Address - Country:US
Practice Address - Phone:843-276-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006636207K00000X
SC31305207R00000X, 207RA0201X
DEDEA#BD7946429207R00000X
OH35-088393207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE100016773Medicaid
DEH69423Medicare UPIN