Provider Demographics
NPI:1669637682
Name:MEDEUS, CHRISTY FAGG (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTY
Middle Name:FAGG
Last Name:MEDEUS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:FAGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:3700 S MAIN ST
Practice Address - Street 2:MONTGOMERY HOSPITALIST
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7017
Practice Address - Country:US
Practice Address - Phone:540-953-5331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116020704207R00000X
VA0102203117207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine