Healthcare Provider Details

I. General information

NPI: 1568997534
Provider Name (Legal Business Name): KATHRYN FIDELER MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON ROAD SUITE 220
MIAMI BEACH FL
33140-2988
US

IV. Provider business mailing address

2445 ARMY NAVY DR
ARLINGTON VA
22206-2988
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2090
  • Fax: 305-674-2093
Mailing address:
  • Phone: 703-892-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101275883
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME162547
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: