Provider Demographics
NPI:1356348007
Name:WILLIAMS, ANTHONY VAN DYKE (MD, FACP)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:VAN DYKE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:ATT: CVMC FINACE DEPT
Mailing Address - City:BARRE
Mailing Address - State:VT
Mailing Address - Zip Code:05641-0547
Mailing Address - Country:US
Mailing Address - Phone:802-479-3302
Mailing Address - Fax:802-225-5720
Practice Address - Street 1:225 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BARRE
Practice Address - State:VT
Practice Address - Zip Code:05641-4881
Practice Address - Country:US
Practice Address - Phone:802-479-3302
Practice Address - Fax:802-225-5720
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0007830207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0009356Medicaid
VT9356Medicare PIN
VTA99752Medicare UPIN
VT0009356Medicaid