Provider Demographics
NPI:1467402719
Name:HARLEY, WILLIAM BEN II (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BEN
Last Name:HARLEY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-7680
Mailing Address - Fax:704-316-9368
Practice Address - Street 1:1900 RANDOLPH RD STE 216
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1106
Practice Address - Country:US
Practice Address - Phone:704-316-5330
Practice Address - Fax:704-316-5332
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9400518207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8939559Medicaid
SCN00518Medicaid
NC8939559Medicaid
NC2199982JMedicare PIN