Provider Demographics
NPI:1174840813
Name:WILLARD AMOSS MD LLC
Entity Type:Organization
Organization Name:WILLARD AMOSS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-877-3822
Mailing Address - Street 1:2303 BEL AIR RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-2737
Mailing Address - Country:US
Mailing Address - Phone:410-877-3822
Mailing Address - Fax:410-877-7781
Practice Address - Street 1:2303 BEL AIR RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2737
Practice Address - Country:US
Practice Address - Phone:410-877-3822
Practice Address - Fax:410-877-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0004354208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1127OtherMEDICARE
MD001431100Medicaid
C48830Medicare UPIN