Provider Demographics
NPI:1033238647
Name:ASHLEY, WILLIAM WALLACE JR (MD, PHD, MBA)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALLACE
Last Name:ASHLEY
Suffix:JR
Gender:M
Credentials:MD, PHD, MBA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5051 GREENSPRING AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4354
Mailing Address - Country:US
Mailing Address - Phone:410-601-4417
Mailing Address - Fax:410-601-7138
Practice Address - Street 1:5051 GREENSPRING AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4354
Practice Address - Country:US
Practice Address - Phone:410-601-4417
Practice Address - Fax:410-601-7138
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD82113207T00000X
IL036.118598207T00000X
TXN4263207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD520486540OtherEMPLOYER TAX ID