Provider Demographics
NPI:1295058394
Name:WILLIAMS, MICHAEL BRANDON (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRANDON
Last Name:WILLIAMS
Suffix:
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 1:225 CLEARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1815
Mailing Address - Country:US
Mailing Address - Phone:757-457-5177
Mailing Address - Fax:757-452-3494
Practice Address - Street 1:225 CLEARFIELD AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1815
Practice Address - Country:US
Practice Address - Phone:757-457-5177
Practice Address - Fax:757-452-3494
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1955208800000X
VA0101249728208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CJ669OtherBCBS
TXP00881579OtherRR MEDICARE
TX216173901Medicaid
VAVV3472AMedicare PIN
TXTXB107313Medicare PIN