Provider Demographics
NPI:1417956277
Name:FENICHEL, ADAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:S
Last Name:FENICHEL
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 1:1285 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4949
Mailing Address - Country:US
Mailing Address - Phone:407-647-2287
Mailing Address - Fax:407-643-2801
Practice Address - Street 1:1285 ORANGE AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-4949
Practice Address - Country:US
Practice Address - Phone:407-647-2287
Practice Address - Fax:407-643-2801
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0064153207XS0106X, 207X00000X
FLME64153207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL200019558OtherRAILROAD
FL23425OtherBC/BS
FL373657100Medicaid
FL200019558OtherRAILROAD
FLF48073Medicare UPIN