MEDICARE: WILLIAM R SHORT 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	207RI0200X	Infectious Disease Physician	MD069187L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669414827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM R SHORT MD

Provider Business Mailing Address
First Line	:	3910 N POWELTON AVE
Second Line	:	2ND FLR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2640
Country	:	US
Telephone Number	:	215-662-9008
Fax Number	:

Provider Business Practice Location Address
First Line	:	3910 N POWELTON AVE
Second Line	:	2ND FLR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-2640
Country	:	US
Telephone Number	:	215-662-9008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	08/26/2015

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