Provider Demographics
NPI:1184893588
Name:NESHANNOCK SURGICAL INC., P.C.
Entity type:Organization
Organization Name:NESHANNOCK SURGICAL INC., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:NORTHWOOD
Authorized Official - Last Name:GILLELAND
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:724-652-3616
Mailing Address - Street 1:26 NESBITT RD
Mailing Address - Street 2:SUITE 151
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-3410
Mailing Address - Country:US
Mailing Address - Phone:724-652-3616
Mailing Address - Fax:724-656-6679
Practice Address - Street 1:26 NESBITT RD
Practice Address - Street 2:SUITE 151
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-3410
Practice Address - Country:US
Practice Address - Phone:724-652-3616
Practice Address - Fax:724-656-6679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046830L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014666800005Medicaid
PA0014666800005Medicaid