Provider Demographics
NPI:1578672531
Name:FENTON, BARBARA A (MD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-0388
Mailing Address - Country:US
Mailing Address - Phone:540-932-4629
Mailing Address - Fax:540-932-4616
Practice Address - Street 1:53 S MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2333
Practice Address - Country:US
Practice Address - Phone:540-932-5687
Practice Address - Fax:540-932-5688
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11174207R00000X
VA0101036000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY123239800OtherMDCD PIN
MT000094706OtherBCBS PIN
MT0157105OtherMDCD PIN
MT1153260006Medicare PIN
VAGC1100Medicare PIN
WY123239800OtherMDCD PIN
MT000085551Medicare PIN
MTP00356153Medicare PIN
MT0157105OtherMDCD PIN