Basic Information
Provider Information
NPI: 1164680096
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOX
FirstName: JENNY
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 91734
Address2:  
City: RICHMOND
State: VA
PostalCode: 232911734
CountryCode: US
TelephoneNumber: 8043586100
FaxNumber: 8043427619
Practice Location
Address1: 1250 E MARSHALL ST
Address2: PEDIATRICS
City: RICHMOND
State: VA
PostalCode: 232985051
CountryCode: US
TelephoneNumber: 8048289783
FaxNumber: 8048288559
Other Information
ProviderEnumerationDate: 05/28/2008
LastUpdateDate: 09/30/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080N0001X0101249019VAY Allopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine

No ID Information.


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