Provider Demographics
NPI: | 1841268315 |
---|---|
Name: | FINTEL, WILLIAM A (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | WILLIAM |
Middle Name: | A |
Last Name: | FINTEL |
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: | 213 S JEFFERSON ST STE 625 |
Mailing Address - Street 2: | |
Mailing Address - City: | ROANOKE |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 24011-1713 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 540-224-5516 |
Mailing Address - Fax: | 540-224-5684 |
Practice Address - Street 1: | 1906 BELLEVIEW AVE SE |
Practice Address - Street 2: | |
Practice Address - City: | ROANOKE |
Practice Address - State: | VA |
Practice Address - Zip Code: | 24014-1838 |
Practice Address - Country: | US |
Practice Address - Phone: | 540-981-7000 |
Practice Address - Fax: | 540-981-8429 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-03-10 |
Last Update Date: | 2020-10-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0101037441 | 207RH0003X, 207RX0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RX0202X | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No | 207RH0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 5847699 | Medicaid | |
VA | 900003162 | Other | RAILROAD MEDICARE |