Healthcare Provider Details

I. General information

NPI: 1477545077
Provider Name (Legal Business Name): ALLISON NICHELLE WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1684 VILLAGE GRN LOWR LEVEL
CROFTON MD
21114-2061
US

IV. Provider business mailing address

1684 VILLAGE GRN LOWR LEVEL
CROFTON MD
21114-2059
US

V. Phone/Fax

Practice location:
  • Phone: 410-721-3822
  • Fax: 410-451-0960
Mailing address:
  • Phone: 410-721-3822
  • Fax: 410-451-0960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0061041
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: