Provider Demographics
NPI:1972887875
Name:MEZZANOTTE, WILLIAM SCHUBERT (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SCHUBERT
Last Name:MEZZANOTTE
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 1:2660 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-2100
Mailing Address - Country:US
Mailing Address - Phone:610-527-4980
Mailing Address - Fax:
Practice Address - Street 1:2660 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-2100
Practice Address - Country:US
Practice Address - Phone:610-527-4980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034338E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease