Provider Demographics
NPI:1912697798
Name:WITHERSPOON, WILLIAM LAFAYETTE
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LAFAYETTE
Last Name:WITHERSPOON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19019 MARKSBURG CT
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-6193
Mailing Address - Country:US
Mailing Address - Phone:240-361-7817
Mailing Address - Fax:
Practice Address - Street 1:19019 MARKSBURG CT
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-6193
Practice Address - Country:US
Practice Address - Phone:240-361-7817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3EW2206343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)