Healthcare Provider Details

I. General information

NPI: 1386678597
Provider Name (Legal Business Name): FIDEL ARTHUR VALEA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/21/2022
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 RIVERSIDE CIR STE 300M
ROANOKE VA
24016-4962
US

IV. Provider business mailing address

1 RIVERSIDE CIR STE 300M
ROANOKE VA
24016-4962
US

V. Phone/Fax

Practice location:
  • Phone: 540-581-0160
  • Fax: 540-345-8487
Mailing address:
  • Phone: 540-581-0160
  • Fax: 540-345-8487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number31668
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number0101261176
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: