Healthcare Provider Details

I. General information

NPI: 1568446599
Provider Name (Legal Business Name): SAMUEL RICHARD WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5707 CALVERTON ST SUITE 1B
CATONSVILLE MD
21228-4154
US

IV. Provider business mailing address

5707 CALVERTON ST SUITE 1B
CATONSVILLE MD
21228-4154
US

V. Phone/Fax

Practice location:
  • Phone: 410-788-2350
  • Fax: 410-788-6859
Mailing address:
  • Phone: 410-788-2350
  • Fax: 410-788-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0024752
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: