Provider Demographics
NPI:1518979129
Name:CRITTENDEN, WILLIAM J III (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:CRITTENDEN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7350 VAN DUSEN RD
Mailing Address - Street 2:350
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5263
Mailing Address - Country:US
Mailing Address - Phone:301-725-6248
Mailing Address - Fax:
Practice Address - Street 1:7350 VAN DUSEN RD
Practice Address - Street 2:350
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5263
Practice Address - Country:US
Practice Address - Phone:301-725-6248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD33588174400000X
MDD0054547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG00650Medicare UPIN
MDH09558Medicare UPIN