Provider Demographics
NPI:1356392211
Name:DENNIS, WILLIAM J (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:DENNIS
Suffix:
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 1:3823 J ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19124-5405
Mailing Address - Country:US
Mailing Address - Phone:215-288-0157
Mailing Address - Fax:215-288-4764
Practice Address - Street 1:3823 J ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19124-5405
Practice Address - Country:US
Practice Address - Phone:215-288-0157
Practice Address - Fax:215-288-4764
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD011421E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
16766OtherBCBS
6130173AOtherCIGNA
PA00652930Medicaid
1025945OtherKEYSTONE MERCY
0055536001OtherKEYSTONE HEALTH PLAN EAST
118185OtherAETNA
6130173AOtherCIGNA