Provider Demographics
NPI:1245382241
Name:JANTSCH, WILLIAM M (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:JANTSCH
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 1:2607 RHAWN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3038
Mailing Address - Country:US
Mailing Address - Phone:215-333-0304
Mailing Address - Fax:215-333-1402
Practice Address - Street 1:2607 RHAWN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3038
Practice Address - Country:US
Practice Address - Phone:215-333-0304
Practice Address - Fax:215-333-1402
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD441854207P00000X
OH35043814207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0554225Medicaid
OH0554225Medicaid
OH0889347Medicare PIN