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General NPI Number Information
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NPI Number | 1154045672
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Entity Type | Individual
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Provider Name | WILLIAM ANTHONY TELLEZ IV
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Gender | Male
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Dates
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Enumeration Date | 09/28/2022
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Last Update Date | 02/19/2025
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Provider Practice Location Address
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Address Line | 255 W LANCASTER AVE SUITE 331 MOB III
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City | PAOLI
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State | PA
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Zip | 19301-1756
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Country | US
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Telephone | 610-527-2232
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Fax |
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Provider Business Mailing Address
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Address Line | 3803 W CHESTER PIKE STE 160
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-2336
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Country | US
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Telephone | 484-337-1632
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA064030
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | OA006262
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License Number State | PA
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