MEDICARE: DR. KEVIN MICHAEL WILLIAMS MD, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	D0059330	MD

General Provider Information

NPI Number	:	1023257979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN MICHAEL WILLIAMS MD, MBA

Provider Business Mailing Address
First Line	:	2 WISCONSIN CIR
Second Line	:	SUITE 700
City	:	CHEVY CHASE
State	:	MD
Zip	:	20815-7003
Country	:	US
Telephone Number	:	703-283-8679
Fax Number	:	703-461-3448

Provider Business Practice Location Address
First Line	:	3737 SEMINARY RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-5202
Country	:	US
Telephone Number	:	703-283-8679
Fax Number	:	703-461-3448

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2009
Last Update Date	:	02/17/2009

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