Provider Demographics
NPI:1932247848
Name:WILLIAM M TRACHTMAN MD PC
Entity Type:Organization
Organization Name:WILLIAM M TRACHTMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRACHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-342-5922
Mailing Address - Street 1:PO BOX 1597
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-0597
Mailing Address - Country:US
Mailing Address - Phone:724-342-5922
Mailing Address - Fax:
Practice Address - Street 1:3150 HIGHLAND RD
Practice Address - Street 2:STE 104
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4516
Practice Address - Country:US
Practice Address - Phone:724-342-5922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049711L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017062030001Medicaid
OH2070324Medicaid
OH2070324Medicaid