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Individual
VINCENT R. FENNELL
Active
Individual
VINCENT R. FENNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A22155
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A221550
BLUE SHIELD
CA
05
—
00A221550
—
CA
05
—
GR0105898
—
CA
05
—
GR0105899
—
CA
05
—
GR0106039
—
CA
Enumeration date
06/14/2006
Last updated
01/31/2014
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