Provider Demographics
NPI:1134196371
Name:SALE, WILLIAM GOODRIDGE III (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GOODRIDGE
Last Name:SALE
Suffix:III
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 1:100 TRACY WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1257
Mailing Address - Country:US
Mailing Address - Phone:304-343-4583
Mailing Address - Fax:304-343-9207
Practice Address - Street 1:100 TRACY WAY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-1257
Practice Address - Country:US
Practice Address - Phone:304-343-4583
Practice Address - Fax:304-343-9207
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12439207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0009333000Medicaid
0486981Medicare PIN
WVA72107Medicare UPIN
9223731Medicare PIN