Provider Demographics
NPI:1063618791
Name:TRUESDALE, WILLIAM M
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:M
Last Name:TRUESDALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1481
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28563-1481
Mailing Address - Country:US
Mailing Address - Phone:252-638-1312
Mailing Address - Fax:252-638-4648
Practice Address - Street 1:2600 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2846
Practice Address - Country:US
Practice Address - Phone:252-638-1312
Practice Address - Fax:252-638-4648
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
224P00000X, 225000000X
NC225000000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795009Medicaid