| Doctor Name: | DR. JEFFREY PAUL FENNELLY |
| NPI Number: | 1760770531 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 0101253447 |
| Business Practice Address: | 210 N Street Camp Lejeune, NC - 28547 |
| Business Phone Number: | 7818357208 |
| Business Fax Number: | |
| Mailing Address: | Po Box 935, SNEADS FERRY |
| State: | NC |
| Postal Code: | 284600935 |
| Phone Number: | 7818357208 |
| Fax Number: | |
| NPI Enumeration Date: | 07/14/2011 |
| NPI Last Update Date: | 12/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101253447 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |