Healthcare Provider Details

I. General information

NPI: 1699749788
Provider Name (Legal Business Name): WILLIAM EDMUND PROMINSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BILL EDMUND PROMINSKI M.D.

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2633
US

IV. Provider business mailing address

6201 GREENLEIGH AVE
BALTIMORE MD
21220-2004
US

V. Phone/Fax

Practice location:
  • Phone: 202-537-4000
  • Fax:
Mailing address:
  • Phone: 410-933-6423
  • Fax: 410-500-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD045791
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101041171
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: