Fennell, Elton G.

Fennell, Elton G. is an individual health care provider with primary practice located at 680 Centre St , Brockton MA 02302-3308. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Obstetrics & Gynecology. Allopathic & Osteopathic Physicians / Obstetrics & Gynecology is his primary health care specialty. Fennell, Elton G. can be contacted via phone (508) 941-7000.

Contact Information

Primary practice address
680 Centre St Brockton MA 02302-3308
Phone: (508) 941-7000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 01074892A Indiana
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 01074892A Indiana
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 235209 Massachusetts

Profile Details

NPI number 1497705891
LBN Legal business name Fennell, Elton G.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 10th, 2006
Last updated Apr 18th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1497705891 NPPES
Massachusetts MEDICAID 2157934
Massachusetts MEDICAID 34312000

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