Individual
MARY G DIANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
12 AVERY PLACE, AVERY CENTER FOR OBSTETRICS & GYNECOLOGY, WESTPORT, CT 06880
(203) 227-5125
Mailing address
16 GEORGETOWN N, GREENWICH, CT 06831-5235
(845) 325-6127
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
200058
NY
207V00000X
Obstetrics & Gynecology Physician
Primary
56749
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01659383
—
NY
01
—
0667910001
DME
NY
01
—
P00413156
MEDICARE RAILROAD
NY
Enumeration date
06/13/2006
Last updated
12/08/2020
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