Provider Demographics
NPI:1740330752
Name:WILLIAMS, PAUL VINCENT (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:VINCENT
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 1:1 CHURCH ST
Mailing Address - Street 2:SUITE 602
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4158
Mailing Address - Country:US
Mailing Address - Phone:240-314-0690
Mailing Address - Fax:
Practice Address - Street 1:1 CHURCH ST
Practice Address - Street 2:SUITE 602
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4158
Practice Address - Country:US
Practice Address - Phone:240-314-0690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00171632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD188271600Medicaid
WI050197Medicare ID - Type Unspecified
MDD05942Medicare UPIN