Provider Demographics
NPI:1144208851
Name:FENTON, ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:
Last Name:FENTON
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 1:341 S MARINE CORPS DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3970
Mailing Address - Country:US
Mailing Address - Phone:671-989-1368
Mailing Address - Fax:
Practice Address - Street 1:341 S MARINE CORPS DR
Practice Address - Street 2:SUITE 104
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3970
Practice Address - Country:US
Practice Address - Phone:671-989-1368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054715A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology