Provider Demographics
NPI:1689655292
Name:OLDS, WILLIAM BELLAMY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BELLAMY
Last Name:OLDS
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 1:757 CARVER DR
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-4431
Mailing Address - Country:US
Mailing Address - Phone:336-597-5553
Mailing Address - Fax:336-597-5034
Practice Address - Street 1:757 CARVER DR
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4431
Practice Address - Country:US
Practice Address - Phone:336-597-5553
Practice Address - Fax:336-597-5034
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8964001Medicaid
NC64001OtherBCBS
NC2139849AMedicare PIN
NC64001OtherBCBS