Provider Demographics
NPI:1356587836
Name:WILLIAMS, RONALD J (LIC AC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PARADISE RD
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-1221
Mailing Address - Country:US
Mailing Address - Phone:978-397-6505
Mailing Address - Fax:
Practice Address - Street 1:11 PARADISE RD
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-1221
Practice Address - Country:US
Practice Address - Phone:978-397-6505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219529171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1356587836Medicaid