MEDICARE: WILLS MEDICAL GROUP PC

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	207Q00000X	Family Medicine Physician	D0050389	MD

General Provider Information

NPI Number	:	1053681460
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLS MEDICAL GROUP PC

Provider Business Mailing Address
First Line	:	14310 OLD MARLBORO PIKE
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-2840
Country	:	US
Telephone Number	:	301-627-1448
Fax Number	:	301-627-5010

Provider Business Practice Location Address
First Line	:	14310 OLD MARLBORO PIKE
Second Line	:
City	:	UPPER MARLBORO
State	:	MD
Zip	:	20772-2840
Country	:	US
Telephone Number	:	301-627-1448
Fax Number	:	301-627-5010

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN H WILLS
Credential	:	MD
Telephone Number	:	301-627-1448

Provider Enumeration Date	:	01/03/2012
Last Update Date	:	04/20/2012

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Directions to “WILLS MEDICAL GROUP PC ” Practice Location

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