Provider Demographics
NPI:1316037153
Name:SOUTHERN, WILLIAM N (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:N
Last Name:SOUTHERN
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 1:19 POKAHOE DR
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1104
Mailing Address - Country:US
Mailing Address - Phone:718-904-2226
Mailing Address - Fax:718-904-2827
Practice Address - Street 1:WEILER - DEPT. OF MEDICINE
Practice Address - Street 2:1825 EASTCHESTER ROAD, 7NW
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461
Practice Address - Country:US
Practice Address - Phone:718-904-2226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine