Provider Demographics
NPI:1194786939
Name:NASUTI, WILLIAM P (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:NASUTI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CRYSTAL A DR
Mailing Address - Street 2:
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-9524
Mailing Address - Country:US
Mailing Address - Phone:833-774-2676
Mailing Address - Fax:717-312-3182
Practice Address - Street 1:100 CRYSTAL A DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-9524
Practice Address - Country:US
Practice Address - Phone:833-774-2676
Practice Address - Fax:717-312-3182
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006158L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01336901OtherBLUE CROSS/CAIC
PA110132212OtherRR MEDICARE
PA0012601670004Medicaid
PW495415OtherAETNA
PA6940OtherHIGHMARK BS
PAB31032Medicare UPIN
PA006940D99Medicare PIN