Provider Demographics
NPI:1902901069
Name:WILLIAM R BOND JR MD LLC
Entity Type:Organization
Organization Name:WILLIAM R BOND JR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RHODEN
Authorized Official - Last Name:BOND
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-871-8245
Mailing Address - Street 1:13228 MOONLIGHT TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-6712
Mailing Address - Country:US
Mailing Address - Phone:301-871-8245
Mailing Address - Fax:301-871-1246
Practice Address - Street 1:106 IRVING ST NW
Practice Address - Street 2:SUITE 312
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2927
Practice Address - Country:US
Practice Address - Phone:202-726-7770
Practice Address - Fax:301-871-1246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025211207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC011409900Medicaid
MD0K4HWROtherBLUECROSS BLUESHIELD
MD1902901069OtherORGANIZATION NPI
MD7808216 04Medicaid
1730124041OtherINDIVIDUAL NPI #
DC5309OtherBLUECROSS BLUESHIELD
DC011400900Medicaid
1730124041OtherINDIVIDUAL NPI #