Provider Demographics
NPI:1093714883
Name:WILLIAMS, RICHARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
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 1:201 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16550-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-6182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030786E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2602625OtherAETNA
NY00940198OtherNY MEDICAID
WV1068774OtherWEST VIRGINIA WORK COMP
PA147543OtherUNISON- IMAGING CENTER
PA1513758OtherGATEWAY
PA417051OtherBLUE SHIELD
PA300098162OtherRR MEDICARE
NY00025260901OtherUNIVERA
PA303645OtherUPMC
PA0010746080009Medicaid
PA086077OtherUNISON - HAMOT RADIOLOGY
OH659210OtherOH MEDICAID
NY00025260901OtherUNIVERA
WV1068774OtherWEST VIRGINIA WORK COMP