Provider Demographics
NPI:1154459196
Name:WILLIAMS RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:WILLIAMS RADIOLOGY ASSOCIATES
Other - Org Name:RUSSELL S WILLIAMS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:802-748-5415
Mailing Address - Street 1:PO BOX 35
Mailing Address - Street 2:
Mailing Address - City:LOWER WATERFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05848-0035
Mailing Address - Country:US
Mailing Address - Phone:802-748-5415
Mailing Address - Fax:802-748-1768
Practice Address - Street 1:170 MIDDLE ST
Practice Address - Street 2:WEEKS MEDICAL CENTER
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584
Practice Address - Country:US
Practice Address - Phone:603-788-4911
Practice Address - Fax:603-788-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH62242085R0202X
MA271162085R0202X
IN01017837A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0000429Medicaid
NH81300429Medicaid
B74371Medicare UPIN
VT0000429Medicaid