Provider Demographics
NPI:1144226846
Name:FENDLEY, MORRIS J (MD)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:J
Last Name:FENDLEY
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:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-437-7989
Mailing Address - Fax:540-437-7984
Practice Address - Street 1:2006 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-5800
Practice Address - Fax:540-689-5801
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234558208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007314116Medicaid
VA466359OtherANTHEM BCBS
WV2005783000Medicaid
VA224789OtherSOUTHERN HEALTH
VA466359OtherANTHEM BCBS
VA001710H71Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
WV2005783000Medicaid