Provider Demographics
NPI:1093855793
Name:WILLIAMS, MARY ELLEN (DO)
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARYELLEN
Other - Middle Name:W
Other - Last Name:KISTLER-STROUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4801 SAUCON CREEK RD
Mailing Address - Street 2:STE 110
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-9068
Mailing Address - Country:US
Mailing Address - Phone:610-625-2010
Mailing Address - Fax:610-625-2314
Practice Address - Street 1:3691 CRESCENT CT E STE 201
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3433
Practice Address - Country:US
Practice Address - Phone:610-434-9561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008484L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016773350004Medicaid
PAG43806Medicare UPIN