Provider Demographics
NPI:1023082401
Name:WILLIAMS, PHILIP COPELAIN JR (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:COPELAIN
Last Name:WILLIAMS
Suffix:JR
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:ONE ELIZABETH PLACE
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45408
Mailing Address - Country:US
Mailing Address - Phone:937-228-4156
Mailing Address - Fax:937-228-0247
Practice Address - Street 1:ONE ELIZABETH PLACE
Practice Address - Street 2:SUITE 10A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45408
Practice Address - Country:US
Practice Address - Phone:937-228-4156
Practice Address - Fax:937-228-0247
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044614208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0465741Medicaid
OHD31251Medicare UPIN
WI0502922Medicare PIN