Healthcare Provider Details

I. General information

NPI: 1932478617
Provider Name (Legal Business Name): REGINALD D WILLS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 EVARTS ST NE
WASHINGTON DC
20018-3710
US

IV. Provider business mailing address

1263 EVARTS ST NE
WASHINGTON DC
20018-3710
US

V. Phone/Fax

Practice location:
  • Phone: 202-635-1600
  • Fax: 202-529-4425
Mailing address:
  • Phone: 202-635-1600
  • Fax: 202-529-4425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD8436
License Number StateDC

VIII. Authorized Official

Name: REGINALD DOUGLAS WILLLS
Title or Position: PRESIDENT
Credential: MD
Phone: 202-635-1600