Provider Demographics
NPI:1487072799
Name:FEYZEAU, KEAN O (MD)
Entity type:Individual
Prefix:
First Name:KEAN
Middle Name:O
Last Name:FEYZEAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:825 FAIRFAX AVE., 6TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-2007
Mailing Address - Country:US
Mailing Address - Phone:757-446-8937
Mailing Address - Fax:757-446-8951
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:RALEIGH BUILDINE, SUITE #304
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-388-3397
Practice Address - Fax:757-388-2885
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101264443207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101264443OtherVIRGINIA STATE MEDICAL LICENSE
VA0101264443OtherVIRGINIA STATE MEDICAL LICENSE