# DR. RANDALL CLARK FENTON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1629077359
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 9962 | NH | Yes |

## Other

- **Enumeration date:** 07/15/2005
- **Last updated:** 02/08/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0100419YPNH01 | ANTHEM BCBS NEW HAMPSHIRE | — |
| 01 | — | 2637002 | AETNA | — |
| 01 | — | 407866 | UNIFORMED SERVICES FAMILY | — |
| 01 | — | 66951 | CIGNA | — |
| 01 | — | 71838 | HARVARD PILGRIM HEALTHCAR | — |
| 01 | — | 753299 | TUFTS HEALTHPLAN | — |
| 01 | — | J17896 | BCBS OF MASSACHUSETTS | — |