Provider Demographics
NPI:1043750227
Name:WILLIAMS, MICHAEL XAVIER
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:XAVIER
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 KEYSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17074
Mailing Address - Country:US
Mailing Address - Phone:646-546-9456
Mailing Address - Fax:
Practice Address - Street 1:848 KEYSTONE WAY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:PA
Practice Address - Zip Code:17074
Practice Address - Country:US
Practice Address - Phone:646-546-9456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA31394113390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program