MEDICARE: DR. ROBERT GARY FENTON M.D., PH.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	207RX0202X	Medical Oncology Physician	0101246955	VA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386687358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GARY FENTON M.D., PH.D.

Provider Business Mailing Address
First Line	:	6400 ARLINGTON BLVD STE 940
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-2336
Country	:	US
Telephone Number	:	240-447-2512
Fax Number	:	703-241-7723

Provider Business Practice Location Address
First Line	:	6400 ARLINGTON BLVD STE 940
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-2336
Country	:	US
Telephone Number	:	240-447-2512
Fax Number	:	703-241-7723

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	04/26/2010

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