Provider Demographics
NPI:1699481002
Name:ALSTON, WILLIAM III
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:ALSTON
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6558 LANSDOWNE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-3706
Mailing Address - Country:US
Mailing Address - Phone:267-694-3039
Mailing Address - Fax:
Practice Address - Street 1:6558 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-3706
Practice Address - Country:US
Practice Address - Phone:267-694-3039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA766869332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies