Provider Demographics
NPI:1093093783
Name:NECHES, WILLIAM HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HAROLD
Last Name:NECHES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5229 STRATHMORE AVE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1119
Mailing Address - Country:US
Mailing Address - Phone:240-475-4077
Mailing Address - Fax:240-303-2512
Practice Address - Street 1:5229 STRATHMORE AVE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1119
Practice Address - Country:US
Practice Address - Phone:240-475-4077
Practice Address - Fax:240-303-2512
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 013226E2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0716573Medicaid
PAB 37517OtherUPIN
PA0716573Medicaid