Provider Demographics
NPI:1003077538
Name:WILLIAMS, EMMA REBECCA (MD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:REBECCA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17001 SCIENCE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-4329
Mailing Address - Country:US
Mailing Address - Phone:240-556-1000
Mailing Address - Fax:
Practice Address - Street 1:17001 SCIENCE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4329
Practice Address - Country:US
Practice Address - Phone:240-556-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0079494207Q00000X
NC201101170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC86480UOtherUPIN