Provider Demographics
NPI:1003143488
Name:WILLIAMS, MICHAEL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 ELDER AVENUE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3005
Mailing Address - Country:US
Mailing Address - Phone:610-623-1433
Mailing Address - Fax:610-623-9678
Practice Address - Street 1:215 ELDER AVENUE
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:PA
Practice Address - Zip Code:19050-3005
Practice Address - Country:US
Practice Address - Phone:610-623-1433
Practice Address - Fax:610-623-9678
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039870E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAFW1853604OtherDEA
PAFW1853604OtherDEA