Provider Demographics
NPI:1427129154
Name:CADDICK, WILLIAM J (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:CADDICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2544 COURT DR
Mailing Address - Street 2:STE H
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-3450
Mailing Address - Country:US
Mailing Address - Phone:704-854-9990
Mailing Address - Fax:704-854-9045
Practice Address - Street 1:2544 COURT DR
Practice Address - Street 2:STE H
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-3450
Practice Address - Country:US
Practice Address - Phone:704-854-9990
Practice Address - Fax:704-854-9045
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC33956207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902001Medicaid
NCE86900Medicare UPIN
NC2160548AMedicare ID - Type Unspecified