Provider Demographics
NPI:1013425453
Name:WILLIAMS, MARCI ANN (OTC)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HIGHLAND AVE STE 16
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3873
Mailing Address - Country:US
Mailing Address - Phone:978-462-7555
Mailing Address - Fax:
Practice Address - Street 1:21 HIGHLAND AVE STE 16
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3873
Practice Address - Country:US
Practice Address - Phone:978-462-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16-0810207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine