Provider Demographics
NPI:1346202744
Name:DEWAR, WILLIAM RUSSELL III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:DEWAR
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 1:1839 FAIR AVE
Mailing Address - Street 2:
Mailing Address - City:HONESDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18431-2121
Mailing Address - Country:US
Mailing Address - Phone:570-251-6500
Mailing Address - Fax:570-253-8195
Practice Address - Street 1:1839 FAIR AVE
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431-2121
Practice Address - Country:US
Practice Address - Phone:570-251-6500
Practice Address - Fax:570-253-8195
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037244L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00069663Medicaid
17953OtherGEISINGER HEALTH PLAN PIN
002316OtherFIRST PRIORITY HEALTH PIN
NY01169846Medicaid
002316OtherFIRST PRIORITY HEALTH PIN
NY01169846Medicaid
PA010058797Medicare PIN