Provider Demographics
NPI:1386607851
Name:TERRY E WILLIAMS LLC
Entity type:Organization
Organization Name:TERRY E WILLIAMS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-724-5992
Mailing Address - Street 1:500 MEMORIAL AVENUE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:301-724-5992
Mailing Address - Fax:301-724-0505
Practice Address - Street 1:500 MEMORIAL AVENUE
Practice Address - Street 2:SUITE 301
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-724-5992
Practice Address - Fax:301-724-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D70308Medicare UPIN
790LMedicare ID - Type Unspecified