Individual
GARY R FENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3022 WILLIAMS DR, SUITE 300, FAIRFAX, VA 22031
(703) 573-9800
(703) 573-2959
Mailing address
3022 WILLIAMS DR, SUITE 300, FAIRFAX, VA 22031
(703) 573-9800
(703) 573-2959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101034449
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11007547
RR MEDICARE
—
05
—
6072291
—
VA
Enumeration date
08/04/2006
Last updated
12/01/2014
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