Healthcare Provider Details

I. General information

NPI: 1073502613
Provider Name (Legal Business Name): BINA A FENN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 B GEORGE WASHINGTON MEMORIAL HIGHWAY
YORKTOWN VA
23692
US

IV. Provider business mailing address

2109 HARPERS MILL ROAD
WILLIAMSBURG VA
23185
US

V. Phone/Fax

Practice location:
  • Phone: 757-969-6544
  • Fax: 757-969-6545
Mailing address:
  • Phone: 757-903-5074
  • Fax: 518-395-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number198314-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: