Provider Demographics
NPI:1790724516
Name:CLINE, WILLIAM A (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:CLINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 GRAND CENTRAL MALL
Mailing Address - Street 2:SUITE 2
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4100
Mailing Address - Country:US
Mailing Address - Phone:304-865-4350
Mailing Address - Fax:304-420-5995
Practice Address - Street 1:800 GRAND CENTRAL MALL
Practice Address - Street 2:SUITE 2
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-4100
Practice Address - Country:US
Practice Address - Phone:304-865-4350
Practice Address - Fax:304-420-5995
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.006999208600000X
WV2812208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2307122Medicaid
WV3810000229Medicaid
H56120Medicare UPIN
OH2307122Medicaid
4070294Medicare PIN