Provider Demographics
NPI:1316917859
Name:TRENTON FAMILY MEDICINE
Entity type:Organization
Organization Name:TRENTON FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:GLICKFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-988-9243
Mailing Address - Street 1:304 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:OH
Mailing Address - Zip Code:45067-1461
Mailing Address - Country:US
Mailing Address - Phone:513-988-9243
Mailing Address - Fax:513-988-9369
Practice Address - Street 1:304 EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-1461
Practice Address - Country:US
Practice Address - Phone:513-988-9243
Practice Address - Fax:513-988-9369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0604500Medicaid
OH0604500Medicaid