Provider Demographics
NPI:1003079575
Name:SANAN, CARRIE COOPER-FENSKE (MD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:COOPER-FENSKE
Last Name:SANAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANNE
Other - Last Name:COOPER-FENSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NONE
Mailing Address - Street 1:2830 VICTORY PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-584-4800
Mailing Address - Fax:513-584-0479
Practice Address - Street 1:596 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2123
Practice Address - Country:US
Practice Address - Phone:937-283-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-05
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01083558A207V00000X
OH35.095325207V00000X
KY46698207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100211040Medicaid
OH0070900Medicaid