Provider Demographics
NPI:1225013428
Name:STURGILL FANT, VANESSA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:JEAN
Last Name:STURGILL FANT
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 1:5261 CARROLLTON PIKE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODLAWN
Mailing Address - State:VA
Mailing Address - Zip Code:24381-3030
Mailing Address - Country:US
Mailing Address - Phone:276-238-8876
Mailing Address - Fax:276-238-8886
Practice Address - Street 1:5261 CARROLLTON PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3030
Practice Address - Country:US
Practice Address - Phone:276-238-8876
Practice Address - Fax:276-238-8886
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-234819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010001099Medicaid
VA010001137Medicaid
VA10001129Medicaid
002093C63Medicare ID - Type Unspecified
VA010001137Medicaid
002091C86Medicare PIN
H89228Medicare UPIN