Individual provider Active NPI

Michael Williams, MD

  • Family Medicine Physician
  • Lanham, MD
National Provider Identifier
1003014838
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
D0070342 Issued in MD
Practice address
4483 Forbes Blvd Ste a
Lanham, MD 20706-4377
Phone
(301) 284-8565
NPI assigned
Jul 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TRN9181 FL
Family Medicine Physician 207Q00000X D0070342 MD Primary

Addresses

Primary practice location

4483 Forbes Blvd Ste a
Lanham, MD 20706-4377

Mailing address

7416 Lake Glen Dr
Glenn Dale, MD 20769-2000

Other practice location 1

303 N Clyde Morris Blvd
Daytona Beach, FL 32114-2709
Phone (386) 254-4165

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100505000323 MD Practitioner - Family Practice 3779611140 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
TRN9181FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Phaeton Health Group LLC Family Medicine Current Accepting new patients
Urgent Care Medicine, LLC CurrentSince Mar 6, 2018 Accepting new patients
KH Medical LLC CurrentSince Jul 28, 2024 Accepting new patients

Locations

3059 Solomons Island Rd
#F2
Edgewater, MD 21037
Phone (410) 956-3394

3059 Solomons Island Rd
Ste F2
Edgewater, MD 21037
Phone (410) 956-3394

4483 Forbes Blvd
Ste A
Lanham, MD 20706
Phone (240) 467-5732

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1003014838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7416 LAKE GLEN DR",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207692000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4483 FORBES BLVD STE A",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207064377",
            "telephone_number": "301-284-8565"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 N Clyde Morris Blvd",
            "address_purpose": "LOCATION",
            "city": "Daytona Beach",
            "state": "FL",
            "postal_code": "321142709",
            "country_code": "US",
            "telephone_number": "386-254-4165",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-03",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "TRN9181",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0070342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lanham, MD

Sources for this page

Verify at the official NPI Registry.