Provider Demographics
NPI:1841307360
Name:WILLIAMSON MEDICAL PLLC
Entity type:Organization
Organization Name:WILLIAMSON MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:V
Authorized Official - Last Name:PERSAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-589-4641
Mailing Address - Street 1:4418 RIDGE RD E
Mailing Address - Street 2:WILLAMSON MEDICAL PLLC
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589
Mailing Address - Country:US
Mailing Address - Phone:315-589-4641
Mailing Address - Fax:315-589-9585
Practice Address - Street 1:4418 RIDGE RD E
Practice Address - Street 2:WILLAMSON MEDICAL PLLC
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589
Practice Address - Country:US
Practice Address - Phone:315-589-4641
Practice Address - Fax:315-589-9585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G0180451260OtherBLUE
NY02329519Medicaid
G0180451260OtherBLUE