Provider Demographics
NPI:1730133588
Name:ELLIOTT, WILLIAM MARTIN II (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MARTIN
Last Name:ELLIOTT
Suffix:II
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 1:4750 HEMPSTEAD STATION DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5164
Mailing Address - Country:US
Mailing Address - Phone:800-875-0136
Mailing Address - Fax:937-619-4150
Practice Address - Street 1:500 CHERRY ST
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3306
Practice Address - Country:US
Practice Address - Phone:304-327-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13508207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000143660OtherBLUE CROSS BLUE SHIELD
P00309253OtherRR MEDICARE BLUEFIELD
WV1003314OtherBRICKSTREET
WV3001609OtherBRICKSTREET
WV001827970OtherBLUE CROSS BLUE SHIELD
WV0056780000Medicaid
VA010283205Medicaid
WV000143660OtherBLUE CROSS BLUE SHIELD
WV001827970OtherBLUE CROSS BLUE SHIELD
P00309253OtherRR MEDICARE BLUEFIELD
WV3001609OtherBRICKSTREET