Provider Demographics
NPI:1093125619
Name:FENTO, ASHLEY MARTINEZ (MD)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:MARTINEZ
Last Name:FENTO
Suffix:
Gender:F
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-2021
Mailing Address - Fax:704-316-2025
Practice Address - Street 1:2000 WELLNESS BLVD STE 120
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-3354
Practice Address - Country:US
Practice Address - Phone:704-316-2146
Practice Address - Fax:704-316-2150
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200925207V00000X
NC2018-01590207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology