Provider Demographics
NPI:1104837244
Name:WILLIAMS, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 SUDLEY RD
Mailing Address - Street 2:#206
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:703-368-9234
Mailing Address - Fax:703-368-0505
Practice Address - Street 1:8650 SUDLEY RD
Practice Address - Street 2:#206
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-368-9234
Practice Address - Fax:703-368-0505
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059106208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007309775Medicaid
VA336884OtherBCBS ANTHEM
VA007309775Medicaid
020001399Medicare ID - Type Unspecified