Provider Demographics
NPI:1144208307
Name:WILLIAMS, MARYANNE D (MD)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
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:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:NEW CANTON
Mailing Address - State:VA
Mailing Address - Zip Code:23123-0220
Mailing Address - Country:US
Mailing Address - Phone:434-581-3271
Mailing Address - Fax:434-581-1105
Practice Address - Street 1:25892 N JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:NEW CANTON
Practice Address - State:VA
Practice Address - Zip Code:23123-2234
Practice Address - Country:US
Practice Address - Phone:434-581-3271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041637207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110161790OtherRAILROAD MEDICARE
VA110161790OtherRAILROAD MEDICARE
VA015854C46Medicare PIN