MEDICARE: WILLIAM 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	208000000X	Pediatrics Physician	MD011421E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	16766	OTHER	BCBS
2	6130173A	OTHER	CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1025945	OTHER	KEYSTONE MERCY
5	0055536001	OTHER	KEYSTONE HEALTH PLAN EAST
6	118185	OTHER	AETNA

General Provider Information

NPI Number	:	1356392211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM 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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/08/2007

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