Provider Demographics
NPI: | 1619057734 |
---|---|
Name: | WILLIAMS, MARCUS R (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | MARCUS |
Middle Name: | R |
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: | 80 W WELSH POOL RD |
Mailing Address - Street 2: | SUITE 101S |
Mailing Address - City: | EXTON |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 19341-1233 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 484-483-2745 |
Mailing Address - Fax: | 484-879-4098 |
Practice Address - Street 1: | 80 W WELSH POOL RD |
Practice Address - Street 2: | SUITE 101S |
Practice Address - City: | EXTON |
Practice Address - State: | PA |
Practice Address - Zip Code: | 19341-1233 |
Practice Address - Country: | US |
Practice Address - Phone: | 484-483-2745 |
Practice Address - Fax: | 484-879-4098 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-16 |
Last Update Date: | 2014-02-04 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MD428872 | 207R00000X |
NH | 13610 | 208M00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | |
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NH | 30206557 | Medicaid | |
NH | 30206557 | Medicaid | |
NH | C87188 | Medicare UPIN | |
P00412050 | Medicare PIN |