Provider Demographics
NPI:1366454696
Name:FENNEY, WILLIAM NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NICHOLAS
Last Name:FENNEY
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 1:35 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3009
Mailing Address - Country:US
Mailing Address - Phone:508-778-6363
Mailing Address - Fax:508-778-6677
Practice Address - Street 1:35 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3009
Practice Address - Country:US
Practice Address - Phone:508-778-6363
Practice Address - Fax:508-778-6677
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA51180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
M18249OtherBC
B96400Medicare UPIN
J02420Medicare ID - Type Unspecified