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Deactivated NPI 1306018593 Deactivated / Inactive NPI Male Practitioner

William Bryan Icenhower , MPH

General Practice • Leonardtown, MD

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, William Icenhower has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date March 27, 2008
NPI Deactivation Date June 17, 2021
Total Practice Duration ~13 Years of Practice (2008 – 2021)

Professional Overview & Biography Verified Profile Summary

William Icenhower, MPH was a registered General Practice practicing in Leonardtown, MD. Throughout an active medical career spanning 13 years, William Icenhower provided care at the practice location at 21580 PEABODY ST until profile deactivation on 2021-06-17.

Practice Location & Contact Primary Location

Practice Address

21580 Peabody St

Leonardtown, MD 206502962

Telephone 3014754317
Fax 3014754350
Associated Practice Facility / Clinic
🏢 St. Mary's Health Department Facility NPI 1508163320

Specialty Benchmarks & Practice Insights

Comparative analytics for General Practice in Leonardtown, MD

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 28.6 Yrs
Regional Practice Density
1 Specialists

Practicing in Leonardtown, MD (421 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

General Practice Primary Specialty

NUCC Taxonomy Code: 208D00000X

State License MD D0050093

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Javonna O'brien , FNP-BC

Nurse Practitioner - Family

NPI 1417479395

Family Nurse Practitioner (Board Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated June 17, 2021

Record deactivated on June 17, 2021

NPI Profile Active March 27, 2008

NPI status registered as active in NPPES database

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Updated Practice Location March 27, 2008

Registered at 21580 PEABODY ST, LEONARDTOWN, MD 206502962 (Tel: 3014754317)

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Updated Business Mailing Address March 27, 2008

Registered at 21580 PEABODY ST, P.O. BOX 316, LEONARDTOWN, MD 206500316 (Tel: 3014754317)

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Provider Name / Credentials Updated March 27, 2008

Recorded as WILLIAM ICENHOWER, MPH

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Medical Taxonomy / Specialty Registered (Primary Specialty) March 27, 2008

General Practice (License #D0050093 in MD)

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Initial NPI Registration & Enumeration March 27, 2008

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1306018593
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 27, 2008
Last Update: March 27, 2008
Deactivation Date: June 17, 2021

Mailing Address

21580 Peabody St, P.o. Box 316

Leonardtown, MD 206500316

Phone: 3014754317

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.