MEDICARE: DR. SAMUEL LEVITICUS WILLIAMS III MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	D0076276	MD
2	2084P0800X	Psychiatry Physician	D0076276	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659572956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL LEVITICUS WILLIAMS III MD

Provider Business Mailing Address
First Line	:	1111 WASHINGTON BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-1824
Country	:	US
Telephone Number	:	410-383-8300
Fax Number	:	410-383-3160

Provider Business Practice Location Address
First Line	:	1111 WASHINGTON BLVD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21230-1824
Country	:	US
Telephone Number	:	410-383-8300
Fax Number	:	410-383-3160

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	11/27/2019

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