Provider Demographics
NPI:1861467102
Name:FANNING, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:FANNING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:340 E TOWN ST
Mailing Address - Street 2:SUITE 8-500
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4600
Mailing Address - Country:US
Mailing Address - Phone:614-566-7370
Mailing Address - Fax:614-533-0187
Practice Address - Street 1:340 E TOWN ST
Practice Address - Street 2:SUITE 8-500
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4600
Practice Address - Country:US
Practice Address - Phone:614-566-7370
Practice Address - Fax:614-533-0187
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35046189208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0539288Medicaid
OHFA0515903Medicare PIN
OH0539288Medicaid
OHH444031Medicare PIN