Provider Demographics
NPI:1851379655
Name:WILLIAMS, BRADLEY WARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:WARD
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 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840740363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA371194700OtherBLACK LUNG
VA540506332108OtherTRICARE/CHAMPUS
VA1851379655OtherOPTIMA HEALTH PLAN
VA1851379655OtherINTOTAL
VA1851379655OtherAETNA
VA1851379655OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1851379655OtherANTHEM MEDIGAP
VA1851679655OtherHUMANA MEDICARE
VA1851379655Medicaid
VAP00831117OtherRAILROAD MEDICARE
VA1851679655OtherHUMANA MEDICARE
VA022964C19Medicare PIN