Healthcare Provider Details

I. General information

NPI: 1023005287
Provider Name (Legal Business Name): ANNE CATHERINE FEDYSZEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13506 E BOUNDARY RD SUITE A
MIDLOTHIAN VA
23112-3930
US

IV. Provider business mailing address

13506 E BOUNDARY RD SUITE A
MIDLOTHIAN VA
23112-3930
US

V. Phone/Fax

Practice location:
  • Phone: 804-744-9652
  • Fax: 804-744-1265
Mailing address:
  • Phone: 804-744-9652
  • Fax: 804-744-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: