Basic Information
Provider Information
NPI: 1699724971
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FLOOD
FirstName: WILLIAM
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 854
Address2: MC A410
City: HERSHEY
State: PA
PostalCode: 170330854
CountryCode: US
TelephoneNumber: 7175315995
FaxNumber:  
Practice Location
Address1: 500 UNIVERSITY DR
Address2:  
City: HERSHEY
State: PA
PostalCode: 170332360
CountryCode: US
TelephoneNumber: 8002431455
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/06/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003XMD062493LPAY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

ID Information
IDTypeStateIssuerDescription
1649312000205PA MEDICAID


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