Basic Information
| Provider Information | |||||||||
| NPI: | 1417083114 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TURLEY | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 RICHMOND LN | ||||||||
| Address2: | |||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061171606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8607482147 | ||||||||
| FaxNumber: | 2037569645 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 ROBBINS ST | ||||||||
| Address2: | |||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067082692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037556663 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2007 | ||||||||
| LastUpdateDate: | 06/09/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 026563 | CT | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 55630 | MA | N | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | P01446539 | 01 | CT | RAILROAD MEDICARE | OTHER | 1417083114 | 05 | CT | MEDICAID | 001265636 | 05 | CT | MEDICAID |