Provider Demographics
NPI:1346386760
Name:CHECKLEY, WILLIAM NEVILLE (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NEVILLE
Last Name:CHECKLEY
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 GITTINGS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2423
Mailing Address - Country:US
Mailing Address - Phone:410-685-0550
Mailing Address - Fax:410-955-0036
Practice Address - Street 1:1830 E MONUMENT ST
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-2100
Practice Address - Country:US
Practice Address - Phone:410-955-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDT4686207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDT4686OtherMD IDENTIFICATION AT JHU
MD026854200Medicaid
MDT4686OtherMD IDENTIFICATION AT JHU