Provider Demographics
NPI:1619478336
Name:FENNIE, CHARLES NORRIS (DO)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:NORRIS
Last Name:FENNIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2916 VANGADER DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-1744
Mailing Address - Country:US
Mailing Address - Phone:740-453-0661
Mailing Address - Fax:
Practice Address - Street 1:2916 VANGADER DR
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-1744
Practice Address - Country:US
Practice Address - Phone:740-453-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.016670208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery