Provider Demographics
NPI:1104819168
Name:SADLACK, WILLIAM J (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:SADLACK
Suffix:
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:PO BOX 791372
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-1372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6420 ROCKLEDGE DR
Practice Address - Street 2:SUITE 2200
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7837
Practice Address - Country:US
Practice Address - Phone:301-530-3220
Practice Address - Fax:301-530-4120
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0019207207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD415096100Medicaid
9954OtherCAREFIRST BCBS PROVIDER #
SA074588Medicare ID - Type Unspecified
DC139461Medicare PIN
B93154Medicare UPIN