MEDICARE: JOE JOSEPH FENN MD

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	207RP1001X	Pulmonary Disease Physician	0101243807	VA

General Provider Information

NPI Number	:	1184617466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOE JOSEPH FENN MD

Provider Business Mailing Address
First Line	:	856 J CLYDE MORRIS BLVD
Second Line	:	STE A
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 KINGS WAY
Second Line	:	STE 2200
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2505
Country	:	US
Telephone Number	:	757-645-3460
Fax Number	:	757-645-3461

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	11/26/2013

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