Healthcare Provider Details

I. General information

NPI: 1932173366
Provider Name (Legal Business Name): WILLIAM ROBERT SONNENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 EAST MECHANIC STREET
TITUSVILLE PA
16354
US

IV. Provider business mailing address

119 EAST MECHANIC STREET
TITUSVILLE PA
16354
US

V. Phone/Fax

Practice location:
  • Phone: 814-827-4665
  • Fax: 814-827-4667
Mailing address:
  • Phone: 814-827-4665
  • Fax: 814-827-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD025681E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: