Provider Demographics
NPI:1740280304
Name:MILROTH, WILLIAM L (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:L
Last Name:MILROTH
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:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:MC CONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233-0721
Mailing Address - Country:US
Mailing Address - Phone:717-485-3186
Mailing Address - Fax:717-485-3249
Practice Address - Street 1:318 N 1ST ST
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233-1006
Practice Address - Country:US
Practice Address - Phone:717-485-3186
Practice Address - Fax:717-485-3249
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD008223E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006133060002Medicaid
PA02404100OtherHIGHMARK BLUECROSS
PA000016552OtherHIGHMARK BLUE SHIELD
PA02404100OtherHIGHMARK BLUECROSS
PA000016552OtherHIGHMARK BLUE SHIELD
PA0006133060002Medicaid