Provider Demographics
NPI:1558327999
Name:OMALLEY, WILLIAM E (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:OMALLEY
Suffix:
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 1:1000 SOUTH AVE
Mailing Address - Street 2:BOX 20
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-2733
Mailing Address - Country:US
Mailing Address - Phone:585-341-0366
Mailing Address - Fax:585-371-0681
Practice Address - Street 1:1000 SOUTH AVE
Practice Address - Street 2:BOX 20
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-2733
Practice Address - Country:US
Practice Address - Phone:585-341-0366
Practice Address - Fax:585-371-0681
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01713675Medicaid
NYP010199116OtherBLUE CHOICE
NY00020275401OtherUNIVERA
NY0101630OtherGHI
NY020035954OtherRAILROAD MEDICARE
NY601716OtherMVP
NY101584FLOtherPREFERRED CARE
NY3944OtherBLUE SHIELD
NY000525379001OtherBS WESTERN/COMMUNITY BLUE
NY5003449OtherAETNA
NY5003449OtherAETNA
NYRB6998Medicare PIN