Provider Demographics
NPI:1477545077
Name:WILLIAMS, ALLISON NICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:NICHELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 VILLAGE GRN LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2059
Mailing Address - Country:US
Mailing Address - Phone:410-721-3822
Mailing Address - Fax:410-451-0960
Practice Address - Street 1:1684 VILLAGE GRN LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2061
Practice Address - Country:US
Practice Address - Phone:410-721-3822
Practice Address - Fax:410-451-0960
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061041207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2309297OtherCIGNA PIN
MDP00256991OtherRR MEDICARE
MD226LL347Medicare PIN
MD8162110OtherMAMSI PRIMARY CARE
MD102002OtherJHHC PROVIDER NUMBER
MD406893900Medicaid
MD2162110OtherMAMSI SPECIALIST
MD3749463OtherAETNA CAPITATED
MD7605-0071OtherCAREFIRST BLUECHOICE
MDP16676OtherCAREFIRST MPOS
I00875Medicare UPIN
MD644617-01OtherCAREFIRST MD RENDERING
MD7632643OtherAETNA FEE FOR SERVICE