Provider Demographics
NPI:1134157274
Name:WILLIAMS, CARMEN J (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12233
Mailing Address - Street 2:MD E4-05
Mailing Address - City:RESEARCH TRIANGLE PARK
Mailing Address - State:NC
Mailing Address - Zip Code:27709-2233
Mailing Address - Country:US
Mailing Address - Phone:919-541-2158
Mailing Address - Fax:919-541-0696
Practice Address - Street 1:111 T.W. ALEXANDER DRIVE
Practice Address - Street 2:NIH/NIEHS CRU BUILDING 109
Practice Address - City:RESEARCH TRIANGLE PARK
Practice Address - State:NC
Practice Address - Zip Code:27709
Practice Address - Country:US
Practice Address - Phone:919-541-9899
Practice Address - Fax:919-541-9854
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD041090E207V00000X
NC2008-01487207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017920230007Medicaid
PA036248Medicare ID - Type Unspecified
H12014Medicare UPIN