Provider Demographics
NPI:1093868424
Name:WILLIAMS, MICHAEL T (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4564
Mailing Address - Country:US
Mailing Address - Phone:757-934-1003
Mailing Address - Fax:757-934-1660
Practice Address - Street 1:114 N MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4564
Practice Address - Country:US
Practice Address - Phone:757-934-1003
Practice Address - Fax:757-934-1660
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010133710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA041020OtherANTHEM
NC7906536OtherMEDICAID
VA6040195Medicaid
VA6040195Medicaid
VA110001647Medicare UPIN