Provider Demographics
NPI:1619971017
Name:O'NEILL, WILLIAM J
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 DAVIE AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3521
Mailing Address - Country:US
Mailing Address - Phone:704-873-9797
Mailing Address - Fax:704-873-9794
Practice Address - Street 1:1711 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3521
Practice Address - Country:US
Practice Address - Phone:704-873-9797
Practice Address - Fax:704-873-9794
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC187213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8908129Medicaid
NC8908129Medicaid
NC243091BMedicare PIN