Provider Demographics
NPI:1033138169
Name:FENICE, JOHN V (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:V
Last Name:FENICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 ANNAND DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-3719
Mailing Address - Country:US
Mailing Address - Phone:302-998-3334
Mailing Address - Fax:302-998-8985
Practice Address - Street 1:2601 ANNAND DR
Practice Address - Street 2:SUITE 4
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-3719
Practice Address - Country:US
Practice Address - Phone:302-998-3334
Practice Address - Fax:302-998-8985
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA79983207P00000X
DEC1-0007714207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222137644OtherBCBSNJ
NJ900000011100OtherAMERICHOICE
NJ222137644OtherCHAMPUS/TRICARE
NJ0091111Medicaid
DE5134440001Medicare NSC
NJ900000011100OtherAMERICHOICE
I49106Medicare UPIN