Individual
DR. DIETRICH ALBERT FELLNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
813 INDEPENDENCE BLVD, VIRGINIA BEACH, VA 23455-6004
(757) 490-9091
(757) 490-3250
Mailing address
813 INDEPENDENCE BLVD, VIRGINIA BEACH, VA 23455-6004
(757) 490-9091
(757) 490-3250
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0101232452
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010030013
—
VA
01
—
110252
ANTHEM BLUE CROSS
VA
01
—
541206650
TRICARE
VA
Enumeration date
10/20/2005
Last updated
05/09/2013
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