Provider Demographics
NPI:1477544682
Name:LINTHICUM, WILLIAM ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:LINTHICUM
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 1:1 KINGS DR
Mailing Address - Street 2:
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787-2331
Mailing Address - Country:US
Mailing Address - Phone:410-751-1111
Mailing Address - Fax:410-751-1692
Practice Address - Street 1:1 KINGS DR
Practice Address - Street 2:
Practice Address - City:TANEYTOWN
Practice Address - State:MD
Practice Address - Zip Code:21787-2331
Practice Address - Country:US
Practice Address - Phone:410-751-1111
Practice Address - Fax:410-751-1692
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0014317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB66683Medicare UPIN
MD5416Medicare PIN