Provider Demographics
NPI:1598731572
Name:WILLIAMS, MIA F (PA)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:F
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:196 PARKWAY S
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-1234
Mailing Address - Country:US
Mailing Address - Phone:860-444-7400
Mailing Address - Fax:860-444-7401
Practice Address - Street 1:435 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4621
Practice Address - Country:US
Practice Address - Phone:860-444-7400
Practice Address - Fax:860-561-7272
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT001385363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTQ02466Medicare UPIN