Provider Demographics
NPI:1770643280
Name:CONDRELL, WILLIAM ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALEXANDER
Last Name:CONDRELL
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 1:8388 LUNSFORD RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-8834
Mailing Address - Country:US
Mailing Address - Phone:540-341-7439
Mailing Address - Fax:540-341-3055
Practice Address - Street 1:4910 MASSACHUSETTS AVE NW STE 315
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4368
Practice Address - Country:US
Practice Address - Phone:202-244-0812
Practice Address - Fax:202-362-3330
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD19744207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F39259Medicare UPIN
DCG01350W01Medicare PIN