Individual
BRADLEY D FENSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
610 WYOMING AVE, KINGSTON, PA 18704-3702
(570) 283-5806
(570) 283-5807
Mailing address
610 WYOMING AVE, KINGSTON, PA 18704-3702
(570) 288-5441
(570) 288-5842
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD073510L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
069319L3F
GROUP MEMBER PTAN
PA
Enumeration date
08/31/2005
Last updated
01/05/2022
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