Provider Demographics
NPI:1497864011
Name:WILLIAMS, MARY C (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4334 BRAMBLETON AVE
Mailing Address - Street 2:#120
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018
Mailing Address - Country:US
Mailing Address - Phone:540-776-1943
Mailing Address - Fax:540-776-9647
Practice Address - Street 1:4334 BRAMBLETON AVE
Practice Address - Street 2:#120
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018
Practice Address - Country:US
Practice Address - Phone:540-776-1943
Practice Address - Fax:540-776-9647
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01020369952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
E17929Medicare UPIN