Provider Demographics
NPI:1457328080
Name:FEDEI, DIANA CAROL (MD)
Entity type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:CAROL
Last Name:FEDEI
Suffix:
Gender:
Credentials:MD
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:CAROL
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1005 COMMERCIAL LN STE 230
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8149
Mailing Address - Country:US
Mailing Address - Phone:757-923-4500
Mailing Address - Fax:757-923-4607
Practice Address - Street 1:1005 COMMERCIAL LN STE 230
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8149
Practice Address - Country:US
Practice Address - Phone:757-923-4500
Practice Address - Fax:757-923-4607
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101227826207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006216234Medicaid
VA600215472OtherCIGNA
VA7896123OtherAETNA
VA1840790OtherFIRST HEALTH
VA28775OtherOPTIMA
VAB8143OtherMEDCOST
VA0701793OtherUNITED HEALTH
VA245441OtherANTHEM
VA390760OtherMAMSI
VA0701793OtherUNITED HEALTH
VA390760OtherMAMSI