Individual
MAUREEN C FENNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
15005 SHADY GROVE RD, SUITE 340, ROCKVILLE, MD 20850-6340
(240) 238-3760
(240) 238-3765
Mailing address
15005 SHADY GROVE RD, SUITE 340, ROCKVILLE, MD 20850-6340
(240) 238-3760
(240) 238-3765
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
D0044928
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0014
BCBS OF DC GROUP NUMBER
DC
01
—
4787
BCBS OF DC GROUP NUMBER
DC
01
—
61390003
BCBS OF MD INDIVIDUAL NO#
MD
05
—
699545401
—
MD
01
—
H830
BCBS OF MD GROUP NUMBER
MD
Enumeration date
04/03/2006
Last updated
01/17/2014
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