Healthcare Provider Details

I. General information

NPI: 1518942184
Provider Name (Legal Business Name): WILLIAM WILSON MULLINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 11/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 MONTROSE RD SUITE 702
NORTH BETHESDA MD
20852-4817
US

IV. Provider business mailing address

6001 MONTROSE RD SUITE 702
NORTH BETHESDA MD
20852-4817
US

V. Phone/Fax

Practice location:
  • Phone: 301-230-5888
  • Fax: 301-230-2488
Mailing address:
  • Phone: 301-230-5888
  • Fax: 301-230-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD29196
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: