Provider Demographics
NPI:1568623676
Name:FENTON FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:FENTON FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:C
Authorized Official - Last Name:FENTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-894-0063
Mailing Address - Street 1:58 RANGE RD
Mailing Address - Street 2:STE. R-03
Mailing Address - City:WINDHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03087-2026
Mailing Address - Country:US
Mailing Address - Phone:603-894-0063
Mailing Address - Fax:603-894-9727
Practice Address - Street 1:58 RANGE RD
Practice Address - Street 2:STE. R-03
Practice Address - City:WINDHAM
Practice Address - State:NH
Practice Address - Zip Code:03087-2026
Practice Address - Country:US
Practice Address - Phone:603-894-0063
Practice Address - Fax:603-894-9727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M17882OtherBCBS MASSACHUSETTS