Provider Demographics
NPI:1477640860
Name:WILLIAMS, ANDRE O (MD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:O
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 CREAMERY WAY
Mailing Address - Street 2:STE 102
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2533
Mailing Address - Country:US
Mailing Address - Phone:610-280-0340
Mailing Address - Fax:610-280-0750
Practice Address - Street 1:460 CREAMERY WAY
Practice Address - Street 2:STE 102
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2533
Practice Address - Country:US
Practice Address - Phone:610-280-0340
Practice Address - Fax:610-280-0750
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD038212L207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000926481Medicaid
PA050017782OtherRAILROAD MEDICARE
PA050032526OtherRAILROAD MEDICARE
C33722Medicare UPIN
PA050017782OtherRAILROAD MEDICARE