Provider Demographics
NPI:1659572956
Name:WILLIAMS, SAMUEL LEVITICUS III (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:LEVITICUS
Last Name:WILLIAMS
Suffix:III
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 1:1111 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-1824
Mailing Address - Country:US
Mailing Address - Phone:410-383-8300
Mailing Address - Fax:410-383-3160
Practice Address - Street 1:1111 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-1824
Practice Address - Country:US
Practice Address - Phone:410-383-8300
Practice Address - Fax:410-383-3160
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00762762084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD123305000Medicaid