Healthcare Provider Details

I. General information

NPI: 1386064723
Provider Name (Legal Business Name): WILLIAM S PRZYBYSZ III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL PARK SUITE 301
WHEELING WV
26003
US

IV. Provider business mailing address

1 MEDICAL PARK PHYSICIAN BILLING DEPT-NTTC
WHEELING WV
26003
US

V. Phone/Fax

Practice location:
  • Phone: 304-277-2992
  • Fax: 304-277-2179
Mailing address:
  • Phone: 304-243-7181
  • Fax: 304-243-7181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27604
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: