Provider Demographics
NPI:1649213836
Name:NOTTINGHAM, WILLIAM JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:NOTTINGHAM
Suffix:JR
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:PO BOX 5930
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-0930
Mailing Address - Country:US
Mailing Address - Phone:302-993-2453
Mailing Address - Fax:302-993-1393
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 215
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5408
Practice Address - Country:US
Practice Address - Phone:302-998-0900
Practice Address - Fax:302-998-2628
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10001980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001171301Medicaid
DED01100Medicare UPIN
DE0001171301Medicaid