Healthcare Provider Details

I. General information

NPI: 1477908382
Provider Name (Legal Business Name): KAREN PEREIA DIETZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN PEREIRA

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 SAM PERRY BLVD
FREDERICKSBRG VA
22401-4453
US

IV. Provider business mailing address

1001 SAM PERRY BLVD
FREDERICKSBURG VA
22401-4453
US

V. Phone/Fax

Practice location:
  • Phone: 301-273-5394
  • Fax:
Mailing address:
  • Phone: 301-273-5394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101269713
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101269713
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: