Provider Demographics
NPI:1568736015
Name:WILLIAMS, PETER WELLES (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:WELLES
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 SPARKS STATION RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9313
Mailing Address - Country:US
Mailing Address - Phone:410-472-0683
Mailing Address - Fax:410-472-2103
Practice Address - Street 1:4 SPARKS STATION RD
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:MD
Practice Address - Zip Code:21152-9313
Practice Address - Country:US
Practice Address - Phone:410-472-0683
Practice Address - Fax:410-472-2103
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD275122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD76838Medicare UPIN