Provider Demographics
NPI:1821484163
Name:WILLIAMS, MARK DANIEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DANIEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 PLEASANT RUN DR
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8720
Mailing Address - Country:US
Mailing Address - Phone:540-689-5500
Mailing Address - Fax:757-431-7116
Practice Address - Street 1:2509 PLEASANT RUN DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8720
Practice Address - Country:US
Practice Address - Phone:540-689-5500
Practice Address - Fax:757-431-7116
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04750207X00000X
VA0102206634207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821484163Medicaid
KY7100688460Medicaid
IN300041818Medicaid