Healthcare Provider Details

I. General information

NPI: 1891756292
Provider Name (Legal Business Name): WILLIAM OLMSTED
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 N GREENE ST
BALTIMORE MD
21201-1524
US

IV. Provider business mailing address

11128 POST HOUSE CT
POTOMAC MD
20854-2534
US

V. Phone/Fax

Practice location:
  • Phone: 410-605-7175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0015801
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: