Individual
ALLEN R. FENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
351 EDWIN DR, STE 102, VIRGINIA BEACH, VA 23462-4559
(757) 499-5550
Mailing address
860 OMNI BLVD STE 101, NEWPORT NEWS, VA 23606-4430
(757) 232-8769
(757) 232-8875
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101027355
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010014832
—
VA
01
—
462019
ANTHEM
VA
01
—
P00137845
RAILROAD MEDICARE
VA
Enumeration date
06/27/2005
Last updated
03/30/2021
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