Provider Demographics
NPI:1043797376
Name:WILLIAMS, RANDAL (MA)
Entity Type:Individual
Prefix:MR
First Name:RANDAL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 WORCESTER RD
Mailing Address - Street 2:
Mailing Address - City:BARRE
Mailing Address - State:MA
Mailing Address - Zip Code:01005-9002
Mailing Address - Country:US
Mailing Address - Phone:978-355-9222
Mailing Address - Fax:978-355-6321
Practice Address - Street 1:151 WORCESTER RD
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:MA
Practice Address - Zip Code:01005
Practice Address - Country:US
Practice Address - Phone:978-355-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program