Healthcare Provider Details

I. General information

NPI: 1205097391
Provider Name (Legal Business Name): AISOSIOYA A WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AISOSIOYA A SIMMONS MD

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 DIVISION ST
BALTIMORE MD
21217-3121
US

IV. Provider business mailing address

1501 DIVISION ST
BALTIMORE MD
21217-3121
US

V. Phone/Fax

Practice location:
  • Phone: 410-383-8300
  • Fax:
Mailing address:
  • Phone: 410-383-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberD0076489
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0076489
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: