MEDICARE: DR. JOHN HERMAN WILLS M.D.

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	:	1457462806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN HERMAN WILLS M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/09/2007

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