1982644431 NPI number — DR. WILLIAM E PASSODELIS MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982644431 NPI number — DR. WILLIAM E PASSODELIS MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PASSODELIS

Provider First Name:

WILLIAM

Provider Middle Name:

E

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1982644431

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/21/2024

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1670 RIVER RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BEAVER

Provider Business Mailing Address State Name:

PA

Provider Business Mailing Address Postal Code:

15009-2412

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

724-774-5227

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1670 RIVER RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BEAVER

Provider Business Practice Location Address State Name:

PA

Provider Business Practice Location Address Postal Code:

15009-2412

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

724-774-5227

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/06/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  35066851 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 01059792A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 200315510 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
• Identifier: 7692258 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000538713 . This is a "AMTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 102974130 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 751180 . This is a "BUCKEYE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: P00398037 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 0304914 . This is a "BCMH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 0982165 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 000000225226 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: ME78324 . This is a "FLORIDA MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 415018 . This is a "WELLCARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".