MEDICARE: DR. JOSEPH WILLIAM FANELLE 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	2085R0001X	Radiation Oncology Physician	25MA05181300	NJ
2	2085R0001X	Radiation Oncology Physician	MD042008E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578563334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH WILLIAM FANELLE MD

Provider Business Mailing Address
First Line	:	184 FIELD LOOP
Second Line	:
City	:	GLASSBORO
State	:	NJ
Zip	:	08028-3292
Country	:	US
Telephone Number	:	609-501-7489
Fax Number	:	856-575-5012

Provider Business Practice Location Address
First Line	:	1505 W SHERMAN AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360-7059
Country	:	US
Telephone Number	:	568-641-7920
Fax Number	:	856-641-8689

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	06/07/2024

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