Healthcare Provider Details

I. General information

NPI: 1619046224
Provider Name (Legal Business Name): DEAN H. KEDES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LEE ST
CHARLOTTESVILLE VA
22908-0001
US

IV. Provider business mailing address

500 RAY C HUNT DR
CHARLOTTESVILLE VA
22903-2981
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101059214
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: