Provider Demographics
NPI:1194943191
Name:DILLAWAY, WINTHROP CHALMERS III (MD)
Entity type:Individual
Prefix:DR
First Name:WINTHROP
Middle Name:CHALMERS
Last Name:DILLAWAY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WINTHROP
Other - Middle Name:
Other - Last Name:DILLAWAY
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:11 WILLARD PL
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-2947
Mailing Address - Country:US
Mailing Address - Phone:862-268-0986
Mailing Address - Fax:
Practice Address - Street 1:11 WILLARD PL
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-2947
Practice Address - Country:US
Practice Address - Phone:862-268-0986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03845900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06074Medicare UPIN
NJD06074Medicare UPIN