Provider Demographics
NPI:1982671020
Name:CHILDRES, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:CHILDRES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:77 NELSON ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1944
Mailing Address - Country:US
Mailing Address - Phone:315-253-4463
Mailing Address - Fax:315-253-5624
Practice Address - Street 1:77 NELSON ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1944
Practice Address - Country:US
Practice Address - Phone:315-253-4463
Practice Address - Fax:315-253-5624
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-05-04
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Provider Licenses
StateLicense IDTaxonomies
NY237292207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I47466Medicare UPIN