Healthcare Provider Details

I. General information

NPI: 1033479704
Provider Name (Legal Business Name): WILLIAM BLAKE HUNTINGTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WILL HUNTINGTON

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 06/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1088 W BALTIMORE PIKE STE 2407
MEDIA PA
19063
US

IV. Provider business mailing address

PO BOX 350
SELLERSVILLE PA
18960-0350
US

V. Phone/Fax

Practice location:
  • Phone: 610-565-1808
  • Fax:
Mailing address:
  • Phone: 215-723-2333
  • Fax: 215-257-1800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberOS018667
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: