Provider Demographics
NPI:1326165267
Name:TEDFORD, WILLIAM LESLIE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LESLIE
Last Name:TEDFORD
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 1:3001 HIGHLAND AVE.
Mailing Address - Street 2:SUITE D.
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2315
Mailing Address - Country:US
Mailing Address - Phone:513-961-8830
Mailing Address - Fax:513-487-3770
Practice Address - Street 1:3001 HIGHLAND AVE.
Practice Address - Street 2:SUITE D
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2315
Practice Address - Country:US
Practice Address - Phone:513-961-8830
Practice Address - Fax:513-487-3770
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350582602084P0800X, 2084P0804X
OH35.0582602084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0852448Medicaid
E76568Medicare UPIN
OH0852448Medicaid