MEDICARE: MR. WILLIAM LEE CHEATHAM III PA-C

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	363AM0700X	Medical Physician Assistant	C0001128	MD

General Provider Information

NPI Number	:	1467415638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM LEE CHEATHAM III PA-C

Provider Business Mailing Address
First Line	:	13853 TURNMORE RD
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20906-2135
Country	:	US
Telephone Number	:	240-676-0785
Fax Number	:	301-250-7617

Provider Business Practice Location Address
First Line	:	962 WAYNE AVE
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4433
Country	:	US
Telephone Number	:	240-744-0001
Fax Number	:	888-206-0912

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	11/24/2022

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