Provider Demographics
NPI:1043378409
Name:FENN, ARTHUR C (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:C
Last Name:FENN
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 1:1000 S ELISEO DR
Mailing Address - Street 2:#103
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2133
Mailing Address - Country:US
Mailing Address - Phone:415-461-9770
Mailing Address - Fax:415-461-6744
Practice Address - Street 1:1000 S ELISEO DR
Practice Address - Street 2:#103
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2133
Practice Address - Country:US
Practice Address - Phone:415-461-9770
Practice Address - Fax:415-461-6744
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13883207YX0007X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0040017876OtherRAILROAD MCR
CA00G138830Medicaid
CA0040017876OtherRAILROAD MCR
CA00G138830Medicare ID - Type Unspecified