Provider Demographics
NPI:1578596797
Name:WILLIAMS, DOMINIQUE RENE (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:RENE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 CHILDRENS DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2664
Mailing Address - Country:US
Mailing Address - Phone:614-722-6200
Mailing Address - Fax:
Practice Address - Street 1:380 BUTTERFLY GARDENS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7508
Practice Address - Country:US
Practice Address - Phone:614-722-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-082238208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH552980OtherCGS - MEDICARE
OH0269109Medicaid
NC790664CMedicaid
7201554OtherAETNA
2127485OtherMAMSI
VA75215OtherOPTIMA FAMILY CARE
VA75215OtherFAMIS OPTIMA FAMILY CARE
VA10056055Medicaid
2127485OtherMDIPA
2127485OtherALLIANCE
2127485OtherUNITED HEALTHCARE
VA75215OtherOPTIMA HEALTHCARE
NC790664COtherNC ACCESS
541778786OtherCIGNA
VA116633OtherANTHEM BC BS
2127485OtherUNITED HEALTHCARE
2127485OtherOP CHOICE