Provider Demographics
NPI:1891758058
Name:GRADWELL, WILLIAM ALLAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALLAN
Last Name:GRADWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14013 BROOMALL LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3055
Mailing Address - Country:US
Mailing Address - Phone:301-319-8193
Mailing Address - Fax:301-295-2070
Practice Address - Street 1:NATIONAL NAVAL MEDICAL CENTER
Practice Address - Street 2:8901 WISCONSIN AVE
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-319-8193
Practice Address - Fax:301-295-2070
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1013103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical