Basic Information
| Provider Information | |||||||||
| NPI: | 1659576460 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SIMISTER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21182 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103688640 | ||||||||
| FaxNumber: | 4103688644 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 CATON AVENUE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103682414 | ||||||||
| FaxNumber: | 4103683575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | C0001064 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.