Healthcare Provider Details

I. General information

NPI: 1316926769
Provider Name (Legal Business Name): JAMES ADAM FENWICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 BLOOMING GROVE RD
HANOVER PA
17331-7917
US

IV. Provider business mailing address

3421 CONCORD RD
YORK PA
17402-9001
US

V. Phone/Fax

Practice location:
  • Phone: 717-812-7559
  • Fax: 717-632-2422
Mailing address:
  • Phone: 717-812-4090
  • Fax: 717-812-4092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD069752L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: