Provider Demographics
NPI:1154728921
Name:FOX, A RENE (CNA,CMT)
Entity type:Individual
Prefix:
First Name:A
Middle Name:RENE
Last Name:FOX
Suffix:
Gender:M
Credentials:CNA,CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 LITTLE PATUXENT PKWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3728
Mailing Address - Country:US
Mailing Address - Phone:443-454-2728
Mailing Address - Fax:
Practice Address - Street 1:11401 LITTLE PATUXENT PKWY
Practice Address - Street 2:SUITE 108
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3728
Practice Address - Country:US
Practice Address - Phone:443-454-2728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDOOO98669172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDL13903869OtherL13903869