Healthcare Provider Details

I. General information

NPI: 1457327330
Provider Name (Legal Business Name): WILLIAM ALAN LISTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE NATIONAL NAVAL MEDICAL CENTER/ GEN SURGERY DEPARTMENT
BETHESDA MD
20889-5600
US

IV. Provider business mailing address

12822 ROSE GROVE DR
OAK HILL VA
20171-1755
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4345
  • Fax: 301-295-0959
Mailing address:
  • Phone: 703-262-0448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101039319
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: