Healthcare Provider Details

I. General information

NPI: 1487072799
Provider Name (Legal Business Name): KEAN O FEYZEAU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR RALEIGH BUILDINE, SUITE #304
NORFOLK VA
23507
US

IV. Provider business mailing address

825 FAIRFAX AVE., 6TH FLOOR
NORFOLK VA
23507-2007
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-3397
  • Fax: 757-388-2885
Mailing address:
  • Phone: 757-446-8937
  • Fax: 757-446-8951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101264443
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: