Healthcare Provider Details

I. General information

NPI: 1619102225
Provider Name (Legal Business Name): WILLIAM HERMIT REY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 A HARWOOD DRIVE
HARWOOD MD
20776-9771
US

IV. Provider business mailing address

12 A HARWOOD DRIVE
HARWOOD MD
20776-9771
US

V. Phone/Fax

Practice location:
  • Phone: 410-991-6531
  • Fax:
Mailing address:
  • Phone: 410-991-6531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: