Provider Demographics
NPI:1821148610
Name:WILLIAMS, JESSICA L (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
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 1:282 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-3322
Mailing Address - Country:US
Mailing Address - Phone:860-837-6717
Mailing Address - Fax:860-837-6802
Practice Address - Street 1:282 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-837-6717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047548208000000X, 2080B0002X
WI50145-020208000000X
IL036115080208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080B0002XAllopathic & Osteopathic PhysiciansPediatricsObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34771200Medicaid
IL036115080Medicaid
WIBZ9798111OtherDEA
WI0094:01545Medicare PIN
WIBZ9798111OtherDEA
WI521830Medicare Oscar/Certification