Provider Demographics
NPI:1801894589
Name:LAURETTI, WILLIAM J (DC)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:LAURETTI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:16220 S FREDERICK AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4039
Mailing Address - Country:US
Mailing Address - Phone:301-258-8877
Mailing Address - Fax:301-208-1188
Practice Address - Street 1:16220 S FREDERICK AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4039
Practice Address - Country:US
Practice Address - Phone:301-258-8877
Practice Address - Fax:301-208-1188
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD1469-PT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD524355-02OtherCAREFIRST BC/BS MARYLAND
778111OtherPHCS NETWORK
P 1579733OtherFIRST HEALTH NETWORK
MDS973OtherCAREFIRST BC/BS NAT'L CAP
2100731OtherMAMSI/UNITEDHEALTHCARE
MDS973OtherCAREFIRST BC/BS NAT'L CAP
MDU-32167Medicare UPIN