Individual
MATTHEW FENLASON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
132 PROFESSIONAL CIR, WILLIAMSBURG, VA 23185
(757) 232-8769
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
01012205306
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2016
Last updated
03/30/2021
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