Provider Demographics
NPI:1346305851
Name:FENDLEY, ANN EHRKE (MD)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:EHRKE
Last Name:FENDLEY
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 1:1044 DEERHAVEN TER
Mailing Address - Street 2:
Mailing Address - City:STEWARTSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08886-2920
Mailing Address - Country:US
Mailing Address - Phone:610-248-4215
Mailing Address - Fax:
Practice Address - Street 1:430 MEMORIAL PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1573
Practice Address - Country:US
Practice Address - Phone:908-213-3600
Practice Address - Fax:908-213-3601
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07492200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB90179Medicare UPIN