Provider Demographics
NPI:1194798009
Name:FERNANDEZ, ALFRED E (MD)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:E
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 ALBEMARLE DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-5506
Mailing Address - Country:US
Mailing Address - Phone:757-547-4747
Mailing Address - Fax:757-819-7945
Practice Address - Street 1:512 ALBEMARLE DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-5506
Practice Address - Country:US
Practice Address - Phone:757-547-4747
Practice Address - Fax:757-819-7945
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052574207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010181569Medicaid
VA41055OtherSENTARA/OPTIMA
VA541595397OtherMID ATLANTIC SOLUTIONS
VA178856OtherANTHEM
VA541595397OtherTRICARE
VA5271236OtherAETNA
VA541595397OtherCIGNA
VA010181569Medicaid
VA41055OtherSENTARA/OPTIMA