Provider Demographics
NPI:1558423921
Name:WILLIAMS, ASTON B (MD)
Entity Type:Individual
Prefix:
First Name:ASTON
Middle Name:B
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 1:2804 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1706
Mailing Address - Country:US
Mailing Address - Phone:716-832-1776
Mailing Address - Fax:
Practice Address - Street 1:2804 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1706
Practice Address - Country:US
Practice Address - Phone:716-832-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158446207RG0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01028555Medicaid
505857001OtherBLUE CROSS
NY058571Medicare ID - Type Unspecified
C58059Medicare UPIN