Provider Demographics
NPI:1629016860
Name:CONKLIN, WILLIAM T (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:CONKLIN
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 1:4921 ASHBAUGH ROAD
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668
Mailing Address - Country:US
Mailing Address - Phone:724-327-2917
Mailing Address - Fax:
Practice Address - Street 1:225 PENN AVE
Practice Address - Street 2:
Practice Address - City:WILKINSBURG
Practice Address - State:PA
Practice Address - Zip Code:15221-2148
Practice Address - Country:US
Practice Address - Phone:412-923-7405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022212E208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000990286Medicaid
129850Medicare ID - Type Unspecified
PA000990286Medicaid