Provider Demographics
NPI:1285677385
Name:WILLIAMS, RICHARD B (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
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 1:4030 SMITH ROAD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1969
Mailing Address - Country:US
Mailing Address - Phone:513-791-4440
Mailing Address - Fax:513-985-6615
Practice Address - Street 1:4030 SMITH ROAD
Practice Address - Street 2:SUITE 350
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1969
Practice Address - Country:US
Practice Address - Phone:513-791-4440
Practice Address - Fax:513-985-6615
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034879A208200000X
KY22201208200000X
OH35053321208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
240004084OtherMEDICARE RAILROAD
KY64787377Medicaid
311411704OtherTAX ID
OHO628824Medicaid
C69007Medicare UPIN
OHW10583753Medicare ID - Type Unspecified
240004084OtherMEDICARE RAILROAD