Provider Demographics
NPI:1023122363
Name:SEMENOV, DIANE S (PAC)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:S
Last Name:SEMENOV
Suffix:
Gender:F
Credentials:PAC
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:P.O. BOX 1500
Mailing Address - Street 2:BOX W1
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939
Mailing Address - Country:US
Mailing Address - Phone:540-332-7235
Mailing Address - Fax:540-332-7194
Practice Address - Street 1:243 WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939
Practice Address - Country:US
Practice Address - Phone:540-332-7235
Practice Address - Fax:540-332-7235
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110000167363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant