Provider Demographics
NPI:1215934864
Name:MACILWAINE, WILLIAM A (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:MACILWAINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 S PANTOPS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8672
Mailing Address - Country:US
Mailing Address - Phone:434-977-5160
Mailing Address - Fax:434-977-5202
Practice Address - Street 1:110 S PANTOPS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8672
Practice Address - Country:US
Practice Address - Phone:434-977-5160
Practice Address - Fax:434-977-5202
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101032037207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0756400001OtherDMERC
VA010811OtherANTHEM BLUE CROSS
B62517Medicare UPIN