Provider Demographics
NPI:1396742359
Name:WILLIAMS, PERSIS ONEEKA (MD)
Entity type:Individual
Prefix:
First Name:PERSIS
Middle Name:ONEEKA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:P.
Other - Middle Name:ONEEKA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:11 NEVINS ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3514
Mailing Address - Country:US
Mailing Address - Phone:617-787-8181
Mailing Address - Fax:617-787-4644
Practice Address - Street 1:11 NEVINS ST
Practice Address - Street 2:SUITE 303
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-3514
Practice Address - Country:US
Practice Address - Phone:617-787-8181
Practice Address - Fax:617-787-4644
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81022208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3261597Medicaid
MAA29945Medicare ID - Type Unspecified
MA3261597Medicaid