Provider Demographics
NPI:1962582841
Name:DICKEY, WILLIAM T (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:T
Last Name:DICKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 ROTARY ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2254
Mailing Address - Country:US
Mailing Address - Phone:304-599-1709
Mailing Address - Fax:
Practice Address - Street 1:101 STADIUM DRIVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505
Practice Address - Country:US
Practice Address - Phone:304-598-4000
Practice Address - Fax:304-293-6963
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20375207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3002824000Medicaid
WV3002824000Medicaid
WV6033081Medicare ID - Type Unspecified