Healthcare Provider Details

I. General information

NPI: 1528100948
Provider Name (Legal Business Name): WILLIAM W HARLESS M.D. PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 MACCORKLE AVE SE
CHARLESTON WV
25304-1334
US

IV. Provider business mailing address

1400 AFFLINK PL STE 101
TUSCALOOSA AL
35406-2289
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-4949
  • Fax:
Mailing address:
  • Phone: 205-366-9740
  • Fax: 205-344-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number37144
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD23392
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number62961
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number21423
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: