Provider Demographics
NPI:1194741991
Name:DOHENY, WILLIAM ROY (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROY
Last Name:DOHENY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WILLIAMSON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-7610
Mailing Address - Country:US
Mailing Address - Phone:704-799-7811
Mailing Address - Fax:704-799-7812
Practice Address - Street 1:202 WILLIAMSON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-7610
Practice Address - Country:US
Practice Address - Phone:704-799-7811
Practice Address - Fax:704-799-7812
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890175XMedicaid
NCF67110OtherNC UPIN
NC28816OtherNC BCBS
NC890175XMedicaid
NC890175XMedicaid