Provider Demographics
NPI:1518041565
Name:FENTON, ANDREW H (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:H
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 1:400 WABASH AVE
Mailing Address - Street 2:SUITE 335
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2433
Mailing Address - Country:US
Mailing Address - Phone:330-344-6500
Mailing Address - Fax:330-434-6810
Practice Address - Street 1:400 WABASH AVE
Practice Address - Street 2:SUITE 335
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2433
Practice Address - Country:US
Practice Address - Phone:330-344-6500
Practice Address - Fax:330-434-6810
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.055898208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3010904OtherACUTE CARE SURGERY SERVICE MEDICAID GROUP #
OH0687153OtherIND. MEDICARE PTAN FOR ACUTE CARE SURGERY SERVICE
OH9338635OtherPARTNERS PHYSICIAN GROUP MEDICARE GROUP #
OH9382831OtherACUTE CARE SURGERY SERVICE MEDICARE GROUP #
OH1841239274OtherPARTNERS PHYSICIAN GROUP TYPE 2 NPI #
OH2551671OtherPARTNERS PHYSICIAN GROUP MEDICAID GROUP #
OH0832764Medicaid
OH1376779702OtherACUTE CARE SURGERY SERVICE TYPE 2 NPI #
OH0687152Medicare PIN