MEDICARE: MRS. BINA A FENN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	198314-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073502613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BINA A FENN M.D.

Provider Business Mailing Address
First Line	:	2109 HARPERS MILL ROAD
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185
Country	:	US
Telephone Number	:	757-903-5074
Fax Number	:	518-395-9431

Provider Business Practice Location Address
First Line	:	6420 B GEORGE WASHINGTON MEMORIAL HIGHWAY
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692
Country	:	US
Telephone Number	:	757-969-6544
Fax Number	:	757-969-6545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	08/06/2012

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