Healthcare Provider Details

I. General information

NPI: 1003170929
Provider Name (Legal Business Name): CHERYL ELAINE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E PULASKI HWY FL 2
ELKTON MD
21921-6304
US

IV. Provider business mailing address

26 CANTERBURY CT
CHESAPEAKE CITY MD
21915-1835
US

V. Phone/Fax

Practice location:
  • Phone: 443-566-0655
  • Fax:
Mailing address:
  • Phone: 443-566-0655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR01573
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: