Healthcare Provider Details

I. General information

NPI: 1932237971
Provider Name (Legal Business Name): WILLIAM R. LINTHICUM, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KINGS DR
TANEYTOWN MD
21787-2331
US

IV. Provider business mailing address

P.O. BOX 452 1 KINGS DR
TANEYTOWN MD
21787-0452
US

V. Phone/Fax

Practice location:
  • Phone: 410-751-1111
  • Fax: 410-751-1692
Mailing address:
  • Phone: 410-751-1111
  • Fax: 410-751-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0014317
License Number StateMD

VIII. Authorized Official

Name: WILLIAM R. LINTHICUM
Title or Position: OWNER
Credential: M.D.
Phone: 410-751-1111