Provider Demographics
NPI:1457328080
Name:FEDEI, DIANA CAROL (MD)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:CAROL
Last Name:FEDEI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:CAROL
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2790 GODWIN BLVD
Mailing Address - Street 2:#375
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8151
Mailing Address - Country:US
Mailing Address - Phone:757-923-4500
Mailing Address - Fax:757-923-4607
Practice Address - Street 1:2790 GODWIN BLVD
Practice Address - Street 2:#375
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8151
Practice Address - Country:US
Practice Address - Phone:757-923-4500
Practice Address - Fax:757-923-4607
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227826207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA600215472OtherCIGNA
VA0701793OtherUNITED HEALTH
VAB8143OtherMEDCOST
VA28775OtherOPTIMA
VA390760OtherMAMSI
VA245441OtherANTHEM
VA1840790OtherFIRST HEALTH
VA006216234Medicaid
VA7896123OtherAETNA
VA0701793OtherUNITED HEALTH
VA390760OtherMAMSI