Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 13680 | MD |
Y | 213EG0000X | General Practice | 13680 | MD |
N | 1223G0001X | General Practice | DEN1000549 | DC |
N | 213EG0000X | General Practice | DEN1000549 | DC |
NPI | 1003061300 |
---|---|
Provider Name | Dr. Tongela Latarsha Williams |
First Address | Upper Marlboro, MD 20772 |
Second Address | Waldorf, MD 20602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2008 |
Last Update Date | 01/12/2008 |