Provider Demographics
NPI:1528017019
Name:WILLIAMS, CHARLES F JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:F
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3755 E 82ND ST
Mailing Address - Street 2:SUITE 75
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-7335
Mailing Address - Country:US
Mailing Address - Phone:317-926-3739
Mailing Address - Fax:317-921-7478
Practice Address - Street 1:1722 S MEMORIAL DR
Practice Address - Street 2:SUITE F
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-1296
Practice Address - Country:US
Practice Address - Phone:317-926-3739
Practice Address - Fax:317-921-7498
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2011-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN23517207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000087435OtherANTHEM
067844Medicare UPIN
IN074600Medicare ID - Type UnspecifiedNEW CASTLE
000000087435OtherANTHEM