MEDICARE: RICHARD MICHAEL WINTERS

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	1041C0700X	Clinical Social Worker	03463	MD

General Provider Information

NPI Number	:	1396931002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD MICHAEL WINTERS

Provider Business Mailing Address
First Line	:	PO BOX 980
Second Line	:	975 N SOLOMONS ISLAND RD
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678
Country	:	US
Telephone Number	:	410-535-5400
Fax Number	:	410-414-9413

Provider Business Practice Location Address
First Line	:	975 SOLOMONS ISLAND RD N
Second Line	:	SUITE 119
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-3917
Country	:	US
Telephone Number	:	410-535-5400
Fax Number	:	410-414-9413

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

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	07/11/2016

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