Individual
MRS. ALLISON K DIVERS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4320 BRAMBLETON AVE SUITE B, ROANOKE, VA 24018
(540) 345-3556
(540) 342-2193
Mailing address
PO BOX 18237, ROANOKE, VA 24014
(540) 345-3556
(540) 342-2193
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0101231913
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
184066
ANTHEM
VA
01
—
184334
SOUTHERN HEALTH
VA
Enumeration date
04/25/2006
Last updated
07/08/2007
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