MEDICARE: WM. J. DENNIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD01141E	PA

General Provider Information

NPI Number	:	1104950831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WM. J. DENNIS MD

Provider Business Mailing Address
First Line	:	3823 J ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19124-5405
Country	:	US
Telephone Number	:	215-288-0157
Fax Number	:	215-288-4764

Provider Business Practice Location Address
First Line	:	3823 J ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19124-5405
Country	:	US
Telephone Number	:	215-288-0157
Fax Number	:	215-288-4764

Authorized Official
Title or Position	:	PEDIATRICIAN
Name	:	DR. WILLIAM JOHN DENNIS
Credential	:
Telephone Number	:	215-288-0157

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	08/22/2020

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