Basic Information
| Provider Information | |||||||||
| NPI: | 1447206867 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUGHES | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1421 E DRINKER ST | ||||||||
| Address2: | |||||||||
| City: | DUNMORE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185122655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159520792 | ||||||||
| FaxNumber: | 2159520794 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 WALNUT ST STE 500 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556750 | ||||||||
| FaxNumber: | 2159238222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 208600000X | MD054373L | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0017158200004 | 05 | PA | MEDICAID |