Provider Demographics
NPI:1356344964
Name:ROWELL, DIANE L (MD)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:ROWELL
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 1:1368 AMERICAN WAY COURT
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-2940
Mailing Address - Country:US
Mailing Address - Phone:540-587-8612
Mailing Address - Fax:540-587-8619
Practice Address - Street 1:1368 AMERICAN WAY COURT
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2940
Practice Address - Country:US
Practice Address - Phone:540-587-8612
Practice Address - Fax:540-587-8619
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101045721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010141681Medicaid
VAE64583Medicare UPIN
VA010141681Medicaid