Provider Demographics
NPI:1265401707
Name:WILLIAMS, BRADLEY S (DPM)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CHAMBERS HILL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-7304
Mailing Address - Country:US
Mailing Address - Phone:717-709-7922
Mailing Address - Fax:717-263-2055
Practice Address - Street 1:100 CHAMBERS HILL DR STE 101
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-7301
Practice Address - Country:US
Practice Address - Phone:717-709-7986
Practice Address - Fax:717-261-4924
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004762L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA024425Medicare ID - Type Unspecified
PAU90387Medicare UPIN