Provider Demographics
NPI:1902884711
Name:FIEDLER, ADAM JULIUS (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JULIUS
Last Name:FIEDLER
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 1:4800 ELDERSLIE PL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1624
Mailing Address - Country:US
Mailing Address - Phone:804-358-7225
Mailing Address - Fax:
Practice Address - Street 1:7101 JAHNKE RD
Practice Address - Street 2:SUITE 280
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4017
Practice Address - Country:US
Practice Address - Phone:804-272-5508
Practice Address - Fax:804-323-7564
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021515207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006242227Medicaid
VA006242227Medicaid
VA160000453Medicare ID - Type Unspecified