Provider Demographics
NPI:1417982166
Name:WILLIAMS, GREGORY STUART (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:STUART
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-642-3796
Mailing Address - Fax:610-642-2943
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:SUITE 124
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:610-648-0553
Practice Address - Fax:610-640-1390
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD022050E207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007716460002Medicaid
PA0007716460002Medicaid
C33500Medicare UPIN