MEDICARE: DR. WILLIAM NICHOLAS FENNEY MD

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
1	207R00000X	Internal Medicine Physician	MA51180	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	M18249	OTHER		BC

General Provider Information

NPI Number	:	1366454696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM NICHOLAS FENNEY MD

Provider Business Mailing Address
First Line	:	35 CEDAR ST
Second Line	:
City	:	HYANNIS
State	:	MA
Zip	:	02601-3009
Country	:	US
Telephone Number	:	508-778-6363
Fax Number	:	508-778-6677

Provider Business Practice Location Address
First Line	:	35 CEDAR ST
Second Line	:
City	:	HYANNIS
State	:	MA
Zip	:	02601-3009
Country	:	US
Telephone Number	:	508-778-6363
Fax Number	:	508-778-6677

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	09/25/2007

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