Active NPI
William John Oetgen, M.D.
- Specialist
- Waldorf, MD
National Provider Identifier
1073674925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- D0016129
- Practice address
- 12070 Old Line Ctr
Suite 100
Waldorf, MD 20602-2513 - Phone
- (301) 705-7870
- Fax
- (301) 705-9622
- NPI assigned
- Dec 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | D0016129 | MD | Primary |
Addresses
Primary practice location
12070 Old Line Ctr
Suite 100
Waldorf, MD 20602-2513
Mailing address
647 First St
Alexandria, VA 22314-1511
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 463921900 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0016129 | MD | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maryland Healthcare Associates LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Internal Medicine Physician
- Waldorf, MD
- NPI 1699714469
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165968000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1238630400000",
"number": "1073674925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "647 FIRST ST",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223141511"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12070 OLD LINE CTR",
"address_2": "SUITE 100",
"city": "WALDORF",
"state": "MD",
"postal_code": "206022513",
"telephone_number": "301-705-7870",
"fax_number": "301-705-9622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OETGEN",
"first_name": "WILLIAM",
"middle_name": "JOHN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-13",
"last_updated": "2009-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MD",
"license": "D0016129",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "463921900",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waldorf, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.