Healthcare Provider Details

I. General information

NPI: 1801168869
Provider Name (Legal Business Name): WILLIAM DURWOOD WHITTEN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DURWOOD WHITTEN PHD

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 W MADISON ST # 11
BALTIMORE MD
21201-5239
US

IV. Provider business mailing address

10 W MADISON ST #11
BALTIMORE MD
21201-5239
US

V. Phone/Fax

Practice location:
  • Phone: 443-438-7863
  • Fax: 443-957-9485
Mailing address:
  • Phone: 443-438-7863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04983
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: