Provider Demographics
NPI:1982644431
Name:PASSODELIS, WILLIAM E (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:PASSODELIS
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 1:1670 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2412
Mailing Address - Country:US
Mailing Address - Phone:724-774-5227
Mailing Address - Fax:
Practice Address - Street 1:1670 RIVER RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2412
Practice Address - Country:US
Practice Address - Phone:724-774-5227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059792A2085R0202X
OH350668512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102974130Medicaid
OH751180OtherBUCKEYE
IN200315510Medicaid
OH000000225226OtherUNISON
OH415018OtherWELLCARE
OH7692258OtherAETNA
FLME78324OtherFLORIDA MEDICAL LICENSE
OH0304914OtherBCMH
OH0982165Medicaid
OH000000538713OtherAMTHEM
OHP00398037OtherRAILROAD MEDICARE
IN200315510Medicaid
OH7692258OtherAETNA
OH0982165Medicaid
OHP00398037OtherRAILROAD MEDICARE
PA373879FLTMedicare PIN