Provider Demographics
NPI:1992788509
Name:EDDY, WILLIAM S (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:EDDY
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 1:929 ROBBINS AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-2441
Mailing Address - Country:US
Mailing Address - Phone:330-652-5512
Mailing Address - Fax:330-652-5122
Practice Address - Street 1:929 ROBBINS AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-2441
Practice Address - Country:US
Practice Address - Phone:330-652-5512
Practice Address - Fax:330-652-5122
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0575515Medicaid
OH0575515Medicaid