Provider Demographics
NPI:1154327682
Name:PRIN, WILLIAM ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ARTHUR
Last Name:PRIN
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 1:100 PENN ST
Mailing Address - Street 2:STE C
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7897 BLUE SAGE WAY
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-4450
Practice Address - Country:US
Practice Address - Phone:717-870-1279
Practice Address - Fax:717-633-3612
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA019036E207V00000X
FLME134341207RA0401X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0725723Medicaid
PA458966Medicare PIN
PA0725723Medicaid