Provider Demographics
NPI:1275625576
Name:WILLIAMS, TIMOTHY R (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:R
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 1:650 PETER JEFFERSON PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8844
Mailing Address - Country:US
Mailing Address - Phone:434-293-4072
Mailing Address - Fax:434-293-4265
Practice Address - Street 1:650 PETER JEFFERSON PKWY
Practice Address - Street 2:STE 100
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8844
Practice Address - Country:US
Practice Address - Phone:434-293-4072
Practice Address - Fax:434-293-4265
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101241677207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00417608OtherRAILROAD MEDICARE
VA1275625576Medicaid
VA655497OtherSOUTHERN HEALTH
VAC10061OtherMEDICARE GROUP PIN
VA305034OtherANTHEM
VA655497OtherSOUTHERN HEALTH
VA305034OtherANTHEM
VAC10061OtherMEDICARE GROUP PIN