MEDICARE: KATHLEEN N FENTON M.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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	74238	MA

General Provider Information

NPI Number	:	1609801794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN N FENTON M.D.

Provider Business Mailing Address
First Line	:	14805 MAYDALE CT
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20905-5552
Country	:	US
Telephone Number	:	301-384-6122
Fax Number	:

Provider Business Practice Location Address
First Line	:	14805 MAYDALE CT
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20905-5552
Country	:	US
Telephone Number	:	301-384-6122
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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