Healthcare Provider Details

I. General information

NPI: 1962452862
Provider Name (Legal Business Name): ANTONY FERNANDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD # 116A MCGUIRE VAMC
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

4361 BATHGATE ROAD
RICHMOND VA
23234-3581
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax: 804-675-6771
Mailing address:
  • Phone: 804-301-5186
  • Fax: 804-675-6771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number89656
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101055932
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: