Provider Demographics
NPI:1679565782
Name:WILLIAMS, FRED WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:WAYNE
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:PO BOX 5466
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-0466
Mailing Address - Country:US
Mailing Address - Phone:609-406-1250
Mailing Address - Fax:609-406-1249
Practice Address - Street 1:1450 PARKSIDE AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08638-2946
Practice Address - Country:US
Practice Address - Phone:609-406-1250
Practice Address - Fax:609-406-1249
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04097100207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0468304Medicaid
NJ0468304Medicaid