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Individual

WILLIAM JOHN OETGEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
12070 OLD LINE CTR, SUITE 100, WALDORF, MD 20602-2513
(301) 705-7870
(301) 705-9622
Mailing address
647 FIRST ST, ALEXANDRIA, VA 22314-1511

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D0016129
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
463921900
MD
Enumeration date
12/13/2006
Last updated
04/02/2009
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