Provider Demographics
NPI:1497819304
Name:FENTON, WILLIAM STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STANLEY
Last Name:FENTON
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:PO BOX 637676
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7676
Mailing Address - Country:US
Mailing Address - Phone:513-569-6117
Mailing Address - Fax:513-569-5084
Practice Address - Street 1:4125 HAMILTON MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-2262
Practice Address - Country:US
Practice Address - Phone:513-863-6222
Practice Address - Fax:513-863-6478
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH63739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0978376Medicaid
OH0978376Medicaid