Provider Demographics
NPI:1982635488
Name:WILLIAMS, RICHARD BLAND III (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BLAND
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 1:3100 S. HANOVER STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225
Mailing Address - Country:US
Mailing Address - Phone:410-350-8209
Mailing Address - Fax:410-350-8211
Practice Address - Street 1:3100 S. HANOVER STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225
Practice Address - Country:US
Practice Address - Phone:410-350-8209
Practice Address - Fax:410-350-8211
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD18807174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD188581200Medicaid
MD188581200Medicaid
MD9127Medicare PIN