Provider Demographics
NPI:1104819663
Name:FERNANDO, NEVILLE A (MD)
Entity type:Individual
Prefix:DR
First Name:NEVILLE
Middle Name:A
Last Name:FERNANDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NEVILLE
Other - Middle Name:ANTHONY
Other - Last Name:FERNANDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8712 BIDDLE CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-1999
Mailing Address - Country:US
Mailing Address - Phone:540-785-9253
Mailing Address - Fax:540-785-9253
Practice Address - Street 1:CULPEPER REGIONAL HOSPITAL
Practice Address - Street 2:501 SUNSET LANE
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-0000
Practice Address - Country:US
Practice Address - Phone:540-829-4100
Practice Address - Fax:540-829-5713
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101025511207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009203250001Medicaid
PA0009203250001Medicaid
PAFE 125840Medicare ID - Type Unspecified
PAC30935Medicare UPIN
VAMC12501Medicare PIN