Provider Demographics
NPI:1861649642
Name:WILLIAMS, MARK EDWIN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:EDWIN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:6776 SNOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:MD
Mailing Address - Zip Code:21863-3304
Mailing Address - Country:US
Mailing Address - Phone:410-632-1263
Mailing Address - Fax:410-629-1505
Practice Address - Street 1:9714 HEALTHWAY DR # DRL
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1154
Practice Address - Country:US
Practice Address - Phone:410-641-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0003723363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical