Provider Demographics
NPI:1992982730
Name:WILLIAM FENTON M.D.
Entity type:Organization
Organization Name:WILLIAM FENTON M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:FELTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-829-4130
Mailing Address - Street 1:1251 NILLES RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7206
Mailing Address - Country:US
Mailing Address - Phone:513-829-4130
Mailing Address - Fax:513-829-4116
Practice Address - Street 1:1251 NILLES RD
Practice Address - Street 2:SUITE 3
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7206
Practice Address - Country:US
Practice Address - Phone:513-829-4130
Practice Address - Fax:513-829-4116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH063739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP00251Medicare PIN