Provider Demographics
NPI:1568446599
Name:WILLIAMS, SAMUEL RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:RICHARD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5707 CALVERTON ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4154
Mailing Address - Country:US
Mailing Address - Phone:410-788-2350
Mailing Address - Fax:410-788-6859
Practice Address - Street 1:5707 CALVERTON ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4154
Practice Address - Country:US
Practice Address - Phone:410-788-2350
Practice Address - Fax:410-788-6859
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024752208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD138181400Medicaid
MD138181400Medicaid