Healthcare Provider Details

I. General information

NPI: 1134301195
Provider Name (Legal Business Name): WILLIAM DORN III MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10905 FT WASHINGTON RD #402
FT WASHINGTON MD
20744
US

IV. Provider business mailing address

PO BOX 1025
OXON HILL MD
20750
US

V. Phone/Fax

Practice location:
  • Phone: 301-292-1180
  • Fax: 301-292-9825
Mailing address:
  • Phone: 301-292-1180
  • Fax: 301-292-9825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberM37013
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101050048
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD25818
License Number StateDC

VIII. Authorized Official

Name: WILLIAM DORN III
Title or Position: OWNER
Credential: MD
Phone: 301-292-1180