Provider Demographics
NPI:1164683264
Name:GLEASON, WILLIAM NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:NICHOLAS
Last Name:GLEASON
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 1:770 NEWTOWN YARDLEY RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-4501
Mailing Address - Country:US
Mailing Address - Phone:215-968-4901
Mailing Address - Fax:215-968-9718
Practice Address - Street 1:770 NEWTOWN YARDLEY RD
Practice Address - Street 2:SUITE 225
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-4501
Practice Address - Country:US
Practice Address - Phone:215-968-4901
Practice Address - Fax:215-968-9718
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD443072208100000X, 207Q00000X, 208100000X
PAMT192732208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery