Provider Demographics
NPI:1790715324
Name:WILLIAMS, MATHEW R I (MD)
Entity Type:Individual
Prefix:DR
First Name:MATHEW
Middle Name:R
Last Name:WILLIAMS
Suffix:I
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 415662
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5662
Mailing Address - Country:US
Mailing Address - Phone:877-648-2964
Mailing Address - Fax:
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-7185
Practice Address - Fax:212-263-2042
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211283-1174400000X
NY211283208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2724954Medicaid
NV5813EWR591Medicare PIN