Provider Demographics
NPI:1447247135
Name:BAKKEN, WILLIAM W (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
Last Name:BAKKEN
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 1:101 ABBEYVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4603
Mailing Address - Country:US
Mailing Address - Phone:717-291-5991
Mailing Address - Fax:717-291-5806
Practice Address - Street 1:101 ABBEYVILLE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4603
Practice Address - Country:US
Practice Address - Phone:717-291-5991
Practice Address - Fax:717-291-5806
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD016728E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5013034OtherAETNA NON-HMO
PAB34704OtherHEALTH ASSURANCE
PA01486801OtherCAPITAL BLUE CROSS
PA51426 S1QDOtherGEISINGER HEALTH PLAN
PAP002632OtherGATEWAY HEALTH PLAN
PA0007275400001Medicaid
PA064530OtherHIGHMARK BLUE SHIELD
PA515171OtherAETNA HMO
PA01486801OtherCAPITAL BLUE CROSS
PA0007275400001Medicaid