Provider Demographics
NPI:1346393006
Name:FRED W WILLIAMS MD PC
Entity Type:Organization
Organization Name:FRED W WILLIAMS MD PC
Other - Org Name:FRED W WILLIAMS MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-406-1250
Mailing Address - Street 1:PO BOX 5466
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-0466
Mailing Address - Country:US
Mailing Address - Phone:609-406-1250
Mailing Address - Fax:609-406-1249
Practice Address - Street 1:1450 PARKSIDE AV
Practice Address - Street 2:SUITE 10
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-2950
Practice Address - Country:US
Practice Address - Phone:609-406-1250
Practice Address - Fax:609-406-1249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04097100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0085027000OtherKEYSTONE HEALTH PLAN EAST
NJ0468304Medicaid
2K5667OtherHEALTHNET
0085027000OtherAMERIHEALTH
0394723002OtherCIGNA
17988OtherAETNA
MES055OtherOXFORD HEALTH PLANS
NJ1034846OtherHORIZON NJ HEALTH
0085027000OtherAMERIHEALTH
0085027000OtherKEYSTONE HEALTH PLAN EAST
=========OtherTRICARE CHAMPUS
NJ0468304Medicaid
0394723002OtherCIGNA
=========OtherMAGNACARE
=========OtherUNIVERSITY HEALTH PLAN