Healthcare Provider Details

I. General information

NPI: 1477550416
Provider Name (Legal Business Name): WILLIAM CHARLES THORNDYKE MDCM FRCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 29TH ST
ASHLAND KY
41101-1900
US

IV. Provider business mailing address

336 29TH ST
ASHLAND KY
41101-1900
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-4404
  • Fax: 606-325-6822
Mailing address:
  • Phone: 606-324-4404
  • Fax: 606-325-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number29406
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: