Healthcare Provider Details

I. General information

NPI: 1649213240
Provider Name (Legal Business Name): KENNETH H WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 BALTIMORE NATIONAL PIKE STE D
CATONSVILLE MD
21228-3923
US

IV. Provider business mailing address

6501 BALTIMORE NATIONAL PIKE STE D
CATONSVILLE MD
21228-3923
US

V. Phone/Fax

Practice location:
  • Phone: 667-234-2100
  • Fax: 667-234-2944
Mailing address:
  • Phone: 667-234-2100
  • Fax: 667-234-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0033448
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberD0033448
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: