Provider Demographics
NPI:1730185380
Name:TILLEY, WILLIAM SPENCER JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SPENCER
Last Name:TILLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIAM
Other - Middle Name:SPENCER
Other - Last Name:TILLEY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5 ASPEN CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-3124
Mailing Address - Country:US
Mailing Address - Phone:336-274-7581
Mailing Address - Fax:336-274-7584
Practice Address - Street 1:1002 N CHURCH ST
Practice Address - Street 2:STE 202
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1448
Practice Address - Country:US
Practice Address - Phone:336-274-7581
Practice Address - Fax:336-274-7584
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29177207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC210977FMedicare PIN
NCC86783Medicare UPIN