Healthcare Provider Details

I. General information

NPI: 1790264349
Provider Name (Legal Business Name): RENEE L WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7751 BELLE POINT DR
GREENBELT MD
20770-3316
US

IV. Provider business mailing address

9801 APOLLO DR 7875
UPPER MARLBORO MD
20792
US

V. Phone/Fax

Practice location:
  • Phone: 202-438-9742
  • Fax:
Mailing address:
  • Phone: 202-438-9742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number401214
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: