Provider Demographics
NPI:1174521728
Name:WILLIAMS, RONEL R (DC)
Entity type:Individual
Prefix:DR
First Name:RONEL
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18505 MARYLAND HWY
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:MD
Mailing Address - Zip Code:21561-1423
Mailing Address - Country:US
Mailing Address - Phone:301-359-3568
Mailing Address - Fax:
Practice Address - Street 1:607 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:MT LAKE PARK
Practice Address - State:MD
Practice Address - Zip Code:21550-3734
Practice Address - Country:US
Practice Address - Phone:301-334-3160
Practice Address - Fax:301-334-3182
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1108111N00000X
WV366111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDW2110001OtherBLUE CHOICE
329956OtherMAMSI
7016547OtherCIGNA
WV0131153000Medicaid
KBK4OtherCAREFIRST BC/BS
W2110001OtherFEDERAL B/C
MD000174100Medicaid
W2110001OtherFEDERAL B/C