Provider Demographics
NPI:1225040983
Name:FENNELL, MARCIA L (MD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:FENNELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 JEFFERSON DAVIS HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8402
Mailing Address - Country:US
Mailing Address - Phone:540-371-4141
Mailing Address - Fax:540-371-1990
Practice Address - Street 1:611 JEFFERSON DAVIS HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8402
Practice Address - Country:US
Practice Address - Phone:540-371-4141
Practice Address - Fax:540-371-1990
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
011055C57Medicare PIN
D62407Medicare UPIN