Provider Demographics
NPI:1932191186
Name:TADDONIO, WILLIAM S (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:TADDONIO
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 1:193 OLD SWEDE RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1522
Mailing Address - Country:US
Mailing Address - Phone:610-385-3010
Mailing Address - Fax:610-385-3076
Practice Address - Street 1:193 OLD SWEDE RD
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518-1522
Practice Address - Country:US
Practice Address - Phone:610-385-3010
Practice Address - Fax:610-385-3076
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039197E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE12974Medicare UPIN
PA179334Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER