Provider Demographics
NPI:1154461044
Name:FEHRENBACH, DONNA (DO)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:FEHRENBACH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 COUSLER CIR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-1689
Mailing Address - Country:US
Mailing Address - Phone:717-764-0356
Mailing Address - Fax:
Practice Address - Street 1:1701 INNOVATION DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-8815
Practice Address - Country:US
Practice Address - Phone:717-988-0000
Practice Address - Fax:717-782-5716
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008192L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016539880017Medicaid
PA0016539880010Medicaid
PA0016539880017Medicaid
000056SGQMedicare ID - Type Unspecified