Provider Demographics
NPI:1477550416
Name:THORNDYKE, WILLIAM CHARLES (MDCM FRCS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:THORNDYKE
Suffix:
Gender:M
Credentials:MDCM FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 29TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-1900
Mailing Address - Country:US
Mailing Address - Phone:606-324-4404
Mailing Address - Fax:606-325-6822
Practice Address - Street 1:336 29TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-1900
Practice Address - Country:US
Practice Address - Phone:606-324-4404
Practice Address - Fax:606-325-6822
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29406208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0952821Medicaid
KY5188137OtherAETNA
WV0130260000Medicaid
KY64294069Medicaid
KY000000051680OtherANTHEM
KY10806562OtherCAQH
KY340014245OtherRAILROAD MEDICARE
KY64294069Medicaid
KY0510501Medicare PIN