Healthcare Provider Details

I. General information

NPI: 1437146164
Provider Name (Legal Business Name): WILLIAM S PADGETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47149 BUSE RD BLDG 1370
PATUXENT RIVER MD
20670-1540
US

IV. Provider business mailing address

47149 BUSE RD BLDG 1370
PATUXENT RIVER MD
20670-1540
US

V. Phone/Fax

Practice location:
  • Phone: 301-342-0029
  • Fax: 301-757-7380
Mailing address:
  • Phone: 301-342-0029
  • Fax: 301-757-7380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0101051322
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: