Provider Demographics
NPI:1982658811
Name:WIGGINS, DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 STARKEY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-345-8896
Mailing Address - Fax:540-982-7164
Practice Address - Street 1:4461 STARKEY ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-345-8896
Practice Address - Fax:540-343-0722
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042677207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110127677OtherRAILROAD MEDICARE
VA7890997OtherCIGNA
VA1982658811Medicaid
VA287246OtherSOUTHERN HEALTH
VA4293175OtherAETNA
VA263824OtherANTHEM
VA263824OtherANTHEM
B09425Medicare UPIN