Healthcare Provider Details

I. General information

NPI: 1871750273
Provider Name (Legal Business Name): WILLIAM T. CONKLIN, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HOSPITAL WAY KELLY BUILDING
MCKEESPORT PA
15132-2092
US

IV. Provider business mailing address

600 HOSPITAL WAY KELLY BULDLING
MCKEESPORT PA
15132-2092
US

V. Phone/Fax

Practice location:
  • Phone: 412-664-2503
  • Fax: 412-664-2504
Mailing address:
  • Phone: 412-664-2503
  • Fax: 412-664-2504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0009902860003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: WILLIAM T CONKLIN
Title or Position: CEO
Credential: MD
Phone: 412-664-2503