Provider Demographics
NPI:1679211270
Name:GAINEY, WILLIAM C
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:GAINEY
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 1:1 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-4335
Mailing Address - Country:US
Mailing Address - Phone:843-731-2837
Mailing Address - Fax:
Practice Address - Street 1:1 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-4335
Practice Address - Country:US
Practice Address - Phone:843-731-2837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1364831311OtherTRI CARE
CA1364831311OtherU.S. COAST GUARD