Individual
DR. MELISSA K FENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
222 HERLONG AVE S, ROCK HILL, SC 29732-1158
(803) 324-6868
Mailing address
5479 LAKE WYLIE RD, CLOVER, SC 29710-9183
(614) 309-0929
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35079409
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2284974
—
OH
01
—
311229292
GROUP FEDERAL TAX ID#
OH
Enumeration date
10/17/2006
Last updated
05/04/2022
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