1508903956 NPI number — DR. SEAN A WILLIAMS D.C.

Table of content: DR. SEAN A WILLIAMS D.C. (NPI 1508903956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508903956 NPI number — DR. SEAN A WILLIAMS D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
SEAN
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508903956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12417 OCEAN GTWY
Provider Second Line Business Mailing Address:
UNIT 2A
Provider Business Mailing Address City Name:
OCEAN CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21842-9521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-213-8787
Provider Business Mailing Address Fax Number:
410-213-1234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12417 OCEAN GTWY
Provider Second Line Business Practice Location Address:
UNIT 2A
Provider Business Practice Location Address City Name:
OCEAN CITY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21842-9521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-213-8787
Provider Business Practice Location Address Fax Number:
410-213-1234
Provider Enumeration Date:
02/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  S01779 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 61990802 . This is a "BLUE CROSS RENDERING ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 497ACO . This is a "MD BC BS PROVIDER ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: J034-0001 . This is a "BLUE CHOICE ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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