Provider Demographics
NPI:1629084918
Name:WILLIAMS, MATTHEW DAVID (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:DAVID
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3289 WOODBURN ROAD
Mailing Address - Street 2:350 NORTHERN VIRGINIA PULMONARY & CRITICAL CARE ASSOC P
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-641-8616
Mailing Address - Fax:703-641-9468
Practice Address - Street 1:3289 WOODBURN ROAD
Practice Address - Street 2:350 NORTHERN VIRGINIA PULMONARY & CRITICAL CARE ASSOC P
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-641-8616
Practice Address - Fax:703-641-9468
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058124207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010064520Medicaid
H28835Medicare UPIN