Provider Demographics
NPI:1942295084
Name:SQUIRES, WILLIAM A (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:SQUIRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:430 CLAREMONT CT STE 123
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1770
Mailing Address - Country:US
Mailing Address - Phone:804-526-1130
Mailing Address - Fax:804-526-0006
Practice Address - Street 1:430 CLAREMONT CT STE 123
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1770
Practice Address - Country:US
Practice Address - Phone:804-526-1130
Practice Address - Fax:804-526-0006
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101032046207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB07659Medicare UPIN