Provider Demographics
NPI:1285605766
Name:MCCLINTIC, WILLIAM RIDGE (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:RIDGE
Last Name:MCCLINTIC
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 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:1243 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:NY
Practice Address - Zip Code:14871-9230
Practice Address - Country:US
Practice Address - Phone:607-734-3929
Practice Address - Fax:607-734-0781
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003393L207Q00000X
NY184734-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006848720003Medicaid
NY080173354OtherRR MEDICARE PIN
NY0365224Medicaid
NYCC8362OtherRR MEDICARE GROUP
NY080173354OtherRR MEDICARE PIN
NY0365224Medicaid