Provider Demographics
NPI:1134349905
Name:MRVOS, DIANA LOIS (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:LOIS
Last Name:MRVOS
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 1:400 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-1908
Mailing Address - Country:US
Mailing Address - Phone:412-963-1879
Mailing Address - Fax:
Practice Address - Street 1:400 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-1908
Practice Address - Country:US
Practice Address - Phone:412-963-1879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030339E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD030339EOtherMEDICAL LICENSE NUMBER