Provider Demographics
NPI:1053301572
Name:WILLIAMS, CHARLES ROGER III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ROGER
Last Name:WILLIAMS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:66 LEWIS BAY RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5210
Mailing Address - Country:US
Mailing Address - Phone:508-862-7801
Mailing Address - Fax:508-778-9381
Practice Address - Street 1:66 LEWIS BAY RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5210
Practice Address - Country:US
Practice Address - Phone:508-862-7801
Practice Address - Fax:508-778-9381
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA569172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C57161Medicare UPIN
007050088Medicare ID - Type Unspecified