Individual
DIANA ALYCE RIVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
13880 BRADDOCK RD STE 301, CENTREVILLE, VA 20121-2462
(703) 222-2273
(703) 222-6093
Mailing address
13880 BRADDOCK RD STE 301, CENTREVILLE, VA 20121-2462
(703) 222-2773
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0102206745
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891227674
—
NY
Enumeration date
03/30/2017
Last updated
07/29/2022
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