Provider Demographics
NPI:1316947153
Name:FENBERG, WILLIAM HARVEY (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HARVEY
Last Name:FENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 MARK DALE DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1636
Mailing Address - Country:US
Mailing Address - Phone:937-436-2479
Mailing Address - Fax:
Practice Address - Street 1:5824 MARK DALE DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459
Practice Address - Country:US
Practice Address - Phone:937-436-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH38462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0377426Medicaid
OH0457341Medicare ID - Type Unspecified
OH0377426Medicaid
OH4287691Medicare PIN