Provider Demographics
NPI:1407105695
Name:TRUSNOVIC, WILLIAM DANIEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DANIEL
Last Name:TRUSNOVIC
Suffix:JR
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 1:90 W CHESTNUT ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4524
Mailing Address - Country:US
Mailing Address - Phone:724-206-9535
Mailing Address - Fax:724-503-4185
Practice Address - Street 1:90 W CHESTNUT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4524
Practice Address - Country:US
Practice Address - Phone:724-206-9535
Practice Address - Fax:724-503-4185
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16697208D00000X
PAMD-059947-L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06545Medicare UPIN