Provider Demographics
NPI:1043289028
Name:FENSTERMACHER, WILLIAM LEE JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LEE
Last Name:FENSTERMACHER
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1202 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7307
Mailing Address - Country:US
Mailing Address - Phone:910-341-1540
Mailing Address - Fax:910-431-4048
Practice Address - Street 1:9101 OCEAN HWY E
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-7867
Practice Address - Country:US
Practice Address - Phone:910-343-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC104227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP72773Medicare UPIN