Provider Demographics
NPI:1841417862
Name:FENN, ALICIA (MD)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:FENN
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 1:5695 INNOVATION DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-3312
Mailing Address - Country:US
Mailing Address - Phone:614-932-5050
Mailing Address - Fax:614-932-9372
Practice Address - Street 1:5695 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-3312
Practice Address - Country:US
Practice Address - Phone:614-932-5050
Practice Address - Fax:614-932-9372
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH093851208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics