Provider Demographics
NPI:1164520524
Name:DEFEO, WILLIAM THOMAS (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:THOMAS
Last Name:DEFEO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3131 COLLEGE HEIGHTS BLVD
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-4812
Mailing Address - Country:US
Mailing Address - Phone:610-821-0444
Mailing Address - Fax:610-820-7006
Practice Address - Street 1:3131 COLLEGE HEIGHTS BLVD
Practice Address - Street 2:SUITE 1500
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-4812
Practice Address - Country:US
Practice Address - Phone:610-821-0444
Practice Address - Fax:610-820-7006
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001701L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02345900OtherCAPITAL BLUE CROSS
PA01188301OtherCAPITOL BLUE CROSS
PA0041080000OtherINDEPENDENCE BLUE CROSS
PA01188301OtherCAPITOL BLUE CROSS
PA02345900OtherCAPITAL BLUE CROSS
PA013746Medicare PIN