Provider Demographics
NPI:1588605356
Name:PURKERT, WILLIAM JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOHN
Last Name:PURKERT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8527 ARDFOUR LN
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-4507
Mailing Address - Country:US
Mailing Address - Phone:703-425-2823
Mailing Address - Fax:703-425-2686
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-4001
Practice Address - Fax:703-776-7113
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2021-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101035196208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7312601Medicaid
VAB93598Medicare UPIN
VA7312601Medicaid