Provider Demographics
NPI:1255096962
Name:NORTHROP, WILLIAM JR (CHW, PRS, CMS)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:NORTHROP
Suffix:JR
Gender:M
Credentials:CHW, PRS, CMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 COUNTRY PARK DR
Mailing Address - Street 2:
Mailing Address - City:TIPP CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45371-8106
Mailing Address - Country:US
Mailing Address - Phone:614-260-6165
Mailing Address - Fax:
Practice Address - Street 1:4901 COUNTRY PARK DR
Practice Address - Street 2:
Practice Address - City:TIPP CITY
Practice Address - State:OH
Practice Address - Zip Code:45371-8106
Practice Address - Country:US
Practice Address - Phone:614-260-6165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty