Basic Information
| Provider Information | |||||||||
| NPI: | 1861467102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FANNING | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 E TOWN ST | ||||||||
| Address2: | SUITE 8-500 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432154600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145667370 | ||||||||
| FaxNumber: | 6145330187 | ||||||||
| Practice Location | |||||||||
| Address1: | 340 E TOWN ST | ||||||||
| Address2: | SUITE 8-500 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432154600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145667370 | ||||||||
| FaxNumber: | 6145330187 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 35046189 | OH | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 0539288 | 05 | OH | MEDICAID |