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NPI Code Detail

MEDICARE: MR. WILLIAM LEE FENSTERMACHER JR. PA-C

MEDICARE: MR. WILLIAM LEE FENSTERMACHER JR. PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant104227NC

General Provider Information

NPI Number : 1043289028
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. WILLIAM LEE FENSTERMACHER JR. PA-C
Provider Business Mailing Address
First Line : 1202 MEDICAL CENTER DR
Second Line :
City : WILMINGTON
State : NC
Zip : 28401-7307
Country : US
Telephone Number : 910-341-1540
Fax Number : 910-431-4048
Provider Business Practice Location Address
First Line : 9101 OCEAN HWY E
Second Line :
City : LELAND
State : NC
Zip : 28451-7867
Country : US
Telephone Number : 910-343-5464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 10/16/2023

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