Provider Demographics
NPI:1649257395
Name:DORSEY, WILLIAM ROSCOE (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROSCOE
Last Name:DORSEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2591 MIAMISBURG CENTERVILLE RD
Mailing Address - Street 2:STE 201
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-3711
Mailing Address - Country:US
Mailing Address - Phone:937-439-5252
Mailing Address - Fax:937-439-9242
Practice Address - Street 1:2591 MIAMISBURG CENTERVILLE RD
Practice Address - Street 2:STE 201
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-3711
Practice Address - Country:US
Practice Address - Phone:937-439-5252
Practice Address - Fax:937-439-9242
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3897207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0595539Medicaid
OHE95965Medicare UPIN
OH0595539Medicaid
OH0644384Medicare PIN
OHH152911Medicare PIN