Provider Demographics
NPI:1801035696
Name:ORLOV, DIANA (LIC ACUPUNCTURIST)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:ORLOV
Suffix:
Gender:F
Credentials:LIC ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 FISHER ST
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2639
Mailing Address - Country:US
Mailing Address - Phone:617-680-9340
Mailing Address - Fax:
Practice Address - Street 1:48 FISHER ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-2639
Practice Address - Country:US
Practice Address - Phone:617-680-9340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA233906171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist