Provider Demographics
NPI:1093866006
Name:KETCHAM, WILLIAM STEWART (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:STEWART
Last Name:KETCHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:501 HEALTH PARK DR
Mailing Address - Street 2:STE 150
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7051
Mailing Address - Country:US
Mailing Address - Phone:919-772-3487
Mailing Address - Fax:919-772-3446
Practice Address - Street 1:501 HEALTH PARK DR
Practice Address - Street 2:STE 150
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7051
Practice Address - Country:US
Practice Address - Phone:919-772-3487
Practice Address - Fax:919-772-3446
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC29605207N00000X, 207ND0101X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC070014474OtherRR MEDICARE
NC30499OtherPARTNERS
NC4510902OtherAETNA
NC3330875-004OtherCIGNA
NC95508OtherMEDCOST
NC0273LOtherBCBS GROUP NUMBER
NC48795OtherBCBS IND
NC562147357OtherUHC
NC290649OtherMAMSI