Provider Demographics
NPI:1487668174
Name:DICKERMAN, WILLIAM R (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:DICKERMAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:190 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19401-1385
Mailing Address - Country:US
Mailing Address - Phone:610-277-9040
Mailing Address - Fax:610-277-7890
Practice Address - Street 1:190 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 155
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1385
Practice Address - Country:US
Practice Address - Phone:610-277-9040
Practice Address - Fax:610-277-7890
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2016-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS006150L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011443370008Medicaid
PAE69174Medicare UPIN
PAE69174Medicare UPIN