Provider Demographics
NPI:1154306850
Name:CORDER, WILLIAM THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:CORDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2665
Mailing Address - Country:US
Mailing Address - Phone:304-624-7200
Mailing Address - Fax:304-624-0026
Practice Address - Street 1:165 SCOTT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-8847
Practice Address - Country:US
Practice Address - Phone:304-554-0440
Practice Address - Fax:304-624-0026
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00679207K00000X
WV14750207K00000X
PAMD437096207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901036Medicaid
PA001171808Medicaid
WV0071544000Medicaid
NC2040152Medicare PIN
PA001171808Medicaid
WV4205111Medicare PIN
NC5901036Medicaid