Provider Demographics
NPI:1548441801
Name:WILLIAM B. OLDS, MD, PA
Entity type:Organization
Organization Name:WILLIAM B. OLDS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BELLAMY
Authorized Official - Last Name:OLDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-597-5553
Mailing Address - Street 1:757 CARVER DR
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-4431
Mailing Address - Country:US
Mailing Address - Phone:336-597-5553
Mailing Address - Fax:336-597-5034
Practice Address - Street 1:757 CARVER DR
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4431
Practice Address - Country:US
Practice Address - Phone:336-597-5553
Practice Address - Fax:336-597-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26463174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790186Medicaid
NC790186Medicaid
NC2344317Medicare PIN