Provider Demographics
NPI:1679531552
Name:CULLEN, WILLIAM JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:CULLEN
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 1:9910 FRANKLIN SQUARE DR # 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-5412
Mailing Address - Fax:
Practice Address - Street 1:2 LIVEWELL DRIVE
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043
Practice Address - Country:US
Practice Address - Phone:207-467-8988
Practice Address - Fax:207-467-8969
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME22414207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD61947103OtherBSMD PROVIDER NUMBER
MD1012963OtherCIGNA PROVIDER NUMBER
MD8127032OtherMAMSI PROVIDE NUMBER
MD431791201Medicaid
MD4328547OtherAETNA HMO PROVIDER NUMBER
MD8127032OtherOPTIMUM CHOICE PROVIDER #
MD8127032OtherALLIANCE PROVIDER NUMBER
MDP16984OtherCAREFIRST POS PROVIDER #
MD8127032OtherMDIPA PROVIDER NUMBER
MD521186611OtherUNITED HEALTHCARE PROV #
MD4328547OtherAETNAPPO PROVIDER NUMBER
MD9070 0020OtherBSDC PROVIDER NUMBER
DC154182Medicare PIN
MD8127032OtherMAMSI PROVIDE NUMBER
MD8127032OtherALLIANCE PROVIDER NUMBER
MD8127032OtherOPTIMUM CHOICE PROVIDER #