Provider Demographics
NPI:1679199517
Name:FENCIL, CHARLES RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:RAYMOND
Last Name:FENCIL
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 1:3650 JOSEPH SIEWICK DR STE 400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1715
Mailing Address - Country:US
Mailing Address - Phone:703-391-2020
Mailing Address - Fax:
Practice Address - Street 1:3650 JOSEPH SIEWICK DR STE 400
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1715
Practice Address - Country:US
Practice Address - Phone:703-391-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116033954390200000X
VA0101273412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program