Provider Demographics
NPI:1801824396
Name:WILLIAMS, THOMAS JOHN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOHN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRUCE RD
Mailing Address - Street 2:-
Mailing Address - City:HOLBROOK
Mailing Address - State:MA
Mailing Address - Zip Code:02343-1263
Mailing Address - Country:US
Mailing Address - Phone:781-767-2428
Mailing Address - Fax:
Practice Address - Street 1:4 BRUCE RD
Practice Address - Street 2:-
Practice Address - City:HOLBROOK
Practice Address - State:MA
Practice Address - Zip Code:02343-1263
Practice Address - Country:US
Practice Address - Phone:781-767-2428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAR93798Medicare UPIN
MAWI AP0190Medicare ID - Type Unspecified