Basic Information
Provider Information
NPI: 1003807033
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADDINGTON
FirstName: WILLIAM
MiddleName: E
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5450 FRANTZ RD STE 360
Address2:  
City: DUBLIN
State: OH
PostalCode: 430164141
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 73 SPORTSMAN DR
Address2:  
City: MARENGO
State: OH
PostalCode: 433341800
CountryCode: US
TelephoneNumber: 6723304105
FaxNumber: 6145331440
Other Information
ProviderEnumerationDate: 10/31/2005
LastUpdateDate: 06/07/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X34-00-7270-AOHY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
224048005OH MEDICAID


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