Provider Demographics
NPI:1720061443
Name:WILLIAMS, JASON A (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
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 1:250 FAME AVENUE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331
Mailing Address - Country:US
Mailing Address - Phone:717-637-1919
Mailing Address - Fax:717-637-2326
Practice Address - Street 1:250 FAME AVENUE
Practice Address - Street 2:SUITE 225
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331
Practice Address - Country:US
Practice Address - Phone:717-637-1919
Practice Address - Fax:717-637-2326
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10007958207W00000X
MDD0064000207W00000X
PAMD426021207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1720061443OtherNPI
PA1768246OtherBS
PA0933651MOMedicare ID - Type Unspecified