Provider Demographics
NPI:1518945351
Name:WILLIAMS, BRIAN L (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 FLANDERS RD
Mailing Address - Street 2:
Mailing Address - City:NIANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06357-1264
Mailing Address - Country:US
Mailing Address - Phone:860-739-5426
Mailing Address - Fax:860-739-0063
Practice Address - Street 1:248 FLANDERS RD
Practice Address - Street 2:
Practice Address - City:NIANTIC
Practice Address - State:CT
Practice Address - Zip Code:06357-1264
Practice Address - Country:US
Practice Address - Phone:860-739-5426
Practice Address - Fax:860-739-0063
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD12262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51864901Medicaid
121813OtherMEDICARE FQHC
HHCMedicare ID - Type Unspecified
HI51864901Medicaid