Provider Demographics
NPI:1609806892
Name:MCKEOWN, WILLIAM D (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
Last Name:MCKEOWN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1511 WESTOVER TER
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7128
Mailing Address - Country:US
Mailing Address - Phone:336-378-9906
Mailing Address - Fax:336-273-7495
Practice Address - Street 1:1511 WESTOVER TER
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7128
Practice Address - Country:US
Practice Address - Phone:336-378-9906
Practice Address - Fax:336-273-7495
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC20937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8957133Medicaid
NC8957133Medicaid
NCC85444Medicare UPIN