Provider Demographics
NPI:1891757001
Name:FETCHIK, WILLIAM D (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:FETCHIK
Suffix:
Gender:M
Credentials:DO
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Other - First Name:
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Mailing Address - Street 1:409 SOUTH SECOND STREET
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 E 2ND ST
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-1201
Practice Address - Country:US
Practice Address - Phone:717-786-2272
Practice Address - Fax:717-786-8353
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS-004632-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0813577Medicaid
PA0813577Medicaid
PA145793Medicare ID - Type Unspecified