Healthcare Provider Details

I. General information

NPI: 1316917859
Provider Name (Legal Business Name): TRENTON FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 EDGEWOOD DR
TRENTON OH
45067-1461
US

IV. Provider business mailing address

304 EDGEWOOD DR
TRENTON OH
45067-1461
US

V. Phone/Fax

Practice location:
  • Phone: 513-988-9243
  • Fax: 513-988-9369
Mailing address:
  • Phone: 513-988-9243
  • Fax: 513-988-9369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM S GLICKFIELD
Title or Position: PRESIDENT
Credential: MD
Phone: 513-988-9243