Individual
WALID I. FAWAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
207 N 4TH AVE, HOPEWELL, VA 23860-2503
(804) 541-0918
(804) 541-7924
Mailing address
269 MEDICAL PARK BLVD, PETERSBURG, VA 23805-9337
(804) 861-0700
(804) 863-4626
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
0101243555
VA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
0101243555
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477714111
—
VA
Enumeration date
06/24/2008
Last updated
10/10/2013
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