Provider Demographics
NPI:1720067366
Name:FENTON, ANNE L (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:L
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 1:114 WALTHAM ST STE 21
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5409
Mailing Address - Country:US
Mailing Address - Phone:617-848-8553
Mailing Address - Fax:617-848-2937
Practice Address - Street 1:114 WALTHAM ST
Practice Address - Street 2:SUITE 21
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5415
Practice Address - Country:US
Practice Address - Phone:617-848-2937
Practice Address - Fax:617-848-2937
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-12
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA529922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3014762Medicaid
MAJ05328OtherBLUE CROSS BLUE SHIELD
MAJ05328Medicare PIN
J05328Medicare PIN
A58337Medicare UPIN