Provider Demographics
NPI:1497857312
Name:GUEDON, OLIVETTE A (MD)
Entity Type:Individual
Prefix:
First Name:OLIVETTE
Middle Name:A
Last Name:GUEDON
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:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-0097
Mailing Address - Country:US
Mailing Address - Phone:540-446-2278
Mailing Address - Fax:804-545-3995
Practice Address - Street 1:98 15TH ST NW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1600
Practice Address - Country:US
Practice Address - Phone:540-446-2278
Practice Address - Fax:804-545-3995
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101221402207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7076021OtherAETNA
236091OtherANTHEM
1539730OtherUMWA
7076021OtherAETNA
236091OtherANTHEM