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NPI Code Detail

MEDICARE: ELLEN T FLEENOR MD

MEDICARE: ELLEN T FLEENOR 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
1207Q00000XFamily Medicine Physician0101056487VA

General Provider Information

NPI Number : 1790763035
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELLEN T FLEENOR MD
Provider Business Mailing Address
First Line : 9950 COURTHOUSE RD
Second Line :
City : CHARLES CITY
State : VA
Zip : 23030-3434
Country : US
Telephone Number : 804-829-6600
Fax Number : 804-829-6182
Provider Business Practice Location Address
First Line : 9950 COURTHOUSE RD
Second Line :
City : CHARLES CITY
State : VA
Zip : 23030-3434
Country : US
Telephone Number : 804-829-6600
Fax Number : 804-829-6182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2006
Last Update Date : 10/16/2012

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Directions to “ ELLEN T FLEENOR MD” Practice Location

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