Individual
DR. WILLIAM SU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
(410) 521-2200
Mailing address
11781 LEE JACKSON MEMORIAL HWY, SUITE 550, FAIRFAX, VA 22033-3309
(571) 777-5157
(703) 890-2650
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
D0064125
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720024235
TYPE II GROUP NPI
MD
05
—
191502900
—
MD
01
—
C11298
RAILROAD MEDICARE GROUP
MD
Enumeration date
02/19/2007
Last updated
09/29/2015
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