Provider Demographics
NPI:1548363047
Name:PAPPADAKE, WILLIAM I (PSYD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:I
Last Name:PAPPADAKE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 HAMPTON HWY
Mailing Address - Street 2:ASSOCIATES OF YORK
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693
Mailing Address - Country:US
Mailing Address - Phone:757-865-1843
Mailing Address - Fax:757-865-7485
Practice Address - Street 1:205 HAMPTON HWY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693
Practice Address - Country:US
Practice Address - Phone:757-865-1843
Practice Address - Fax:757-865-7485
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001236103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA775112-5Medicaid
133117OtherMHN
096047OtherBCBS VA05
096047OtherBCBS ROANOKE
096047OtherANTHEM HEALTH KEEPERS
022161000OtherMAGELLAN
096047OtherBCBS FEP
096047OtherBCBS PENN
680000305Medicare ID - Type Unspecified