Provider Demographics
NPI:1851380612
Name:WILLIAMS, WENDOL ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:WENDOL
Middle Name:ARTHUR
Last Name:WILLIAMS
Suffix:
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 1:1000 SILVER ST
Mailing Address - Street 2:YNHPH - LV-120
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3940
Mailing Address - Country:US
Mailing Address - Phone:860-262-5868
Mailing Address - Fax:860-262-5055
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:YNHPH - LV-120
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-688-2619
Practice Address - Fax:203-737-2221
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0425732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0014257363Medicaid
CT0014257363Medicaid
CT260004272Medicare ID - Type Unspecified