Healthcare Provider Details

I. General information

NPI: 1982133120
Provider Name (Legal Business Name): WILLIAM SANDERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2017
Last Update Date: 06/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 RITCHIE HWY STE 315
GLEN BURNIE MD
21061-3089
US

IV. Provider business mailing address

7310 RITCHIE HWY STE 315
GLEN BURNIE MD
21061-3089
US

V. Phone/Fax

Practice location:
  • Phone: 443-494-9766
  • Fax: 443-494-9766
Mailing address:
  • Phone: 443-494-9766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: