Healthcare Provider Details

I. General information

NPI: 1841417862
Provider Name (Legal Business Name): ALICIA FENN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 01/11/2024
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5695 INNOVATION DR
DUBLIN OH
43016-3312
US

IV. Provider business mailing address

5695 INNOVATION DR
DUBLIN OH
43016-3312
US

V. Phone/Fax

Practice location:
  • Phone: 614-932-5050
  • Fax: 614-932-9372
Mailing address:
  • Phone: 614-932-5050
  • Fax: 614-932-9372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number093851
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: