Provider Demographics
NPI:1164460929
Name:WILLIAMS, MARVIN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:THOMAS
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 1:2330 CASTLESTONE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-1141
Mailing Address - Country:US
Mailing Address - Phone:804-330-3335
Mailing Address - Fax:804-320-9205
Practice Address - Street 1:3742 WINTERFIELD RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-9238
Practice Address - Country:US
Practice Address - Phone:804-330-3335
Practice Address - Fax:804-320-9205
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026639207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00237582OtherMEDICARE RAILROAD
VAB06553Medicare UPIN
0914020001Medicare NSC
VA008209F28Medicare ID - Type Unspecified