Provider Demographics
NPI:1982133120
Name:SANDERS, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SANDERS
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 1:7310 RITCHIE HWY STE 315
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3089
Mailing Address - Country:US
Mailing Address - Phone:443-494-9766
Mailing Address - Fax:
Practice Address - Street 1:7310 RITCHIE HWY STE 315
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3089
Practice Address - Country:US
Practice Address - Phone:443-494-9766
Practice Address - Fax:443-494-9766
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-10
Last Update Date:2017-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No174400000XOther Service ProvidersSpecialist
No251V00000XAgenciesVoluntary or Charitable
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner