Basic Information
| Provider Information | |||||||||
| NPI: | 1851387021 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HETRICK | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1699 WASHINGTON RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152281629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128511820 | ||||||||
| FaxNumber: | 4128511822 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152195114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4128511820 | ||||||||
| FaxNumber: | 4128511822 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD012241E | PA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 657679 | 05 | PA | MEDICAID |