Provider Demographics
NPI:1356350862
Name:WILLIAMS, EDWARD S (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:S
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:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:610-649-4907
Mailing Address - Fax:610-649-8819
Practice Address - Street 1:100 E LANCASTER AVE STE 451
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3434
Practice Address - Country:US
Practice Address - Phone:610-649-4907
Practice Address - Fax:610-649-8819
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018686E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00214104OtherMEDICARE
PA0688871Medicaid
0053847000OtherPERSONAL CHOICE
0053847000OtherPERSONAL CHOICE 65
D98457Medicare UPIN