Provider Demographics
NPI:1417931650
Name:O'GRADY, WILLIAM PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PATRICK
Last Name:O'GRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3720 SEMINARY RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-5203
Mailing Address - Country:US
Mailing Address - Phone:703-751-7790
Mailing Address - Fax:703-823-2862
Practice Address - Street 1:3720 SEMINARY RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-5203
Practice Address - Country:US
Practice Address - Phone:703-751-7790
Practice Address - Fax:703-823-2862
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAO1010426012085R0202X, 2085R0202X
MDD00370082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD168051000Medicaid
A03358Medicare UPIN
DC016662W30Medicare ID - Type UnspecifiedPROVIDER NUMBER
MD575P191HMedicare PIN
DC016662W30Medicare PIN
470001526Medicare PIN