Provider Demographics
NPI:1770510612
Name:WILLIAMS, JAMESINE R (MD)
Entity Type:Individual
Prefix:
First Name:JAMESINE
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 RIDGEWAY AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4285
Mailing Address - Country:US
Mailing Address - Phone:585-368-4000
Mailing Address - Fax:585-225-2685
Practice Address - Street 1:2655 RIDGEWAY AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4285
Practice Address - Country:US
Practice Address - Phone:585-368-4000
Practice Address - Fax:585-225-2685
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224984207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02357564Medicaid
NYRA0147-GRP:BA0017Medicare PIN
NYDD1830-GRP:70008AMedicare PIN
H66679Medicare UPIN