Provider Demographics
NPI:1306100185
Name:FEDOROVA, VICTORIA (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:FEDOROVA
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1150 VARNUM ST NE
Mailing Address - Street 2:ST. CATHERINE'S HALL/1ST FLOOR/ROOM 102
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2104
Mailing Address - Country:US
Mailing Address - Phone:202-854-4812
Mailing Address - Fax:202-854-7825
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:DEPAUL 021
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2107
Practice Address - Country:US
Practice Address - Phone:202-854-7785
Practice Address - Fax:202-854-7734
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2017-02-14
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Provider Licenses
StateLicense IDTaxonomies
DCMD043513207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine