Provider Demographics
NPI:1336113869
Name:WILLIAMS, CHARLES WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:WESLEY
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 1:4885 TIMBER EDGE
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286
Mailing Address - Country:US
Mailing Address - Phone:330-659-4059
Mailing Address - Fax:216-749-8210
Practice Address - Street 1:7575 NORTHCLIFF AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-3267
Practice Address - Country:US
Practice Address - Phone:216-749-8279
Practice Address - Fax:216-749-8210
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.036999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0891307Medicaid
D31973Medicare UPIN
OH0891307Medicaid