Active NPI
Gladys Susan Fenichel, MD
- Psychosomatic Medicine Physician
- Ardmore, PA
National Provider Identifier
1902024516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychosomatic Medicine Physician
- License
- MD023493E
- Practice address
- 210 Kent Rd
Ardmore, PA 19003-3304 - Phone
- (610) 649-8940
- Fax
- (610) 649-5071
- NPI assigned
- Apr 22, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychosomatic Medicine Physician | 2084P0015X | MD023493E | PA | Primary |
Addresses
Primary practice location
210 Kent Rd
Ardmore, PA 19003-3304
Mailing address
210 Kent Rd
Ardmore, PA 19003-3304
Phone (610) 649-8940
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD023493E | PA | MD | Psychosomatic Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1902024516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 KENT RD",
"city": "ARDMORE",
"state": "PA",
"postal_code": "190033304",
"telephone_number": "610-649-8940",
"fax_number": "610-649-5071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 KENT RD",
"city": "ARDMORE",
"state": "PA",
"postal_code": "190033304",
"telephone_number": "610-649-8940",
"fax_number": "610-649-5071"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FENICHEL",
"first_name": "GLADYS",
"middle_name": "SUSAN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-04-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0015X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychosomatic Medicine",
"state": "PA",
"license": "MD023493E",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ardmore, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.