Provider Demographics
NPI:1154392025
Name:OWENS, DIA P (MD)
Entity type:Individual
Prefix:
First Name:DIA
Middle Name:P
Last Name:OWENS
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 1:602 W MORGAN AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277-2036
Mailing Address - Country:US
Mailing Address - Phone:276-546-5310
Mailing Address - Fax:276-546-5469
Practice Address - Street 1:602 W MORGAN AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-2036
Practice Address - Country:US
Practice Address - Phone:276-546-5310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI21540Medicare UPIN
VA009147S10Medicare PIN