MEDICARE: DR. SALLY ANNE WILLETT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	D0042386	MD

General Provider Information

NPI Number	:	1164515698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALLY ANNE WILLETT M.D.

Provider Business Mailing Address
First Line	:	9841 BROKEN LAND PARKWAY
Second Line	:	SUITE 116
City	:	COLUMBIA
State	:	MD
Zip	:	21046-0000
Country	:	US
Telephone Number	:	301-490-0778
Fax Number	:	301-498-4663

Provider Business Practice Location Address
First Line	:	9841 BROKEN LAND PARKWAY
Second Line	:	SUITE 116
City	:	COLUMBIA
State	:	MD
Zip	:	21046-0000
Country	:	US
Telephone Number	:	301-490-0778
Fax Number	:	301-498-4663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/06/2024

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