Provider Demographics
NPI:1275518268
Name:PHELAN, WILLIAM JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:PHELAN
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 1:419 VILLAGE DR STE 6
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-6943
Mailing Address - Country:US
Mailing Address - Phone:717-245-9101
Mailing Address - Fax:717-245-9036
Practice Address - Street 1:419 VILLAGE DR STE 6
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-6943
Practice Address - Country:US
Practice Address - Phone:717-245-9101
Practice Address - Fax:717-245-9036
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042838E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE12895Medicare UPIN
125555Medicare ID - Type Unspecified