Provider Demographics
NPI:1255390035
Name:GAUGHAN, WILLIAM J (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:GAUGHAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:101 EAST OLNEY AVENUE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-254-2599
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:LEVY GRD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-456-6970
Practice Address - Fax:215-456-7154
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2011-01-06
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Provider Licenses
StateLicense IDTaxonomies
PAMD031609E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001282520Medicaid
PA001282520Medicaid
0000181728Medicare ID - Type Unspecified