Provider Demographics
NPI:1962452862
Name:FERNANDEZ, ANTONY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONY
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4361 BATHGATE ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-3581
Mailing Address - Country:US
Mailing Address - Phone:804-301-5186
Mailing Address - Fax:804-675-6771
Practice Address - Street 1:1201 BROAD ROCK BLVD # 116A
Practice Address - Street 2:MCGUIRE VAMC
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:804-675-6771
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010559322084P0800X
SC896562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7116560Medicaid
VAG48065Medicare UPIN
VA7116560Medicaid