Healthcare Provider Details

I. General information

NPI: 1851430722
Provider Name (Legal Business Name): CHRISTINE GAIL FENTON L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 N SOLOMONS ISLAND ROAD
PRINCE FREDERICK MD
20678
US

IV. Provider business mailing address

975 N SOLOMONS ISLAND ROAD
PRINCE FREDERICK MD
20678
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-5400
  • Fax: 410-414-9413
Mailing address:
  • Phone: 410-535-5400
  • Fax: 410-414-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLC2446
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: