Provider Demographics
NPI:1669473492
Name:WILLIAMSON, EDWARD LLOYD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LLOYD
Last Name:WILLIAMSON
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 1:426 PELLIS RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4574
Mailing Address - Country:US
Mailing Address - Phone:724-838-0090
Mailing Address - Fax:724-838-7717
Practice Address - Street 1:426 PELLIS RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4574
Practice Address - Country:US
Practice Address - Phone:724-838-0090
Practice Address - Fax:724-838-7717
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014362E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0627455Medicaid
PA80330OtherU.S.HEALTHCARE
PA0006513OtherU.M.W.
PA0006513OtherU.M.W.
PAWI127122Medicare ID - Type Unspecified