Provider Demographics
NPI:1285653113
Name:PASSARELLI, WILLIAM O III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:O
Last Name:PASSARELLI
Suffix:III
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 1:4300 HOSPITAL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5329
Mailing Address - Country:US
Mailing Address - Phone:228-762-1002
Mailing Address - Fax:
Practice Address - Street 1:4300 HOSPITAL ST STE 102
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5329
Practice Address - Country:US
Practice Address - Phone:228-762-1002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS17347207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0815455669Medicaid
MS060000547Medicare ID - Type UnspecifiedPROVIDER NO
MS0815455669Medicaid