Provider Demographics
NPI:1386687358
Name:FENTON, ROBERT GARY (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GARY
Last Name:FENTON
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 ARLINGTON BLVD STE 940
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-2336
Mailing Address - Country:US
Mailing Address - Phone:240-447-2512
Mailing Address - Fax:703-241-7723
Practice Address - Street 1:6400 ARLINGTON BLVD STE 940
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-2336
Practice Address - Country:US
Practice Address - Phone:240-447-2512
Practice Address - Fax:703-241-7723
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246955207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037541300Medicaid
MD084403900Medicaid
DC037541300Medicaid
MD424VMedicare PIN
MDG66889Medicare UPIN