Provider Demographics
NPI:1912941469
Name:WILLIAMS, VIRGIL L (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGIL
Middle Name:L
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 1:55 YORKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-2021
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 WILLOW PASS RD
Practice Address - Street 2:STE 110
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-7982
Practice Address - Country:US
Practice Address - Phone:925-691-6432
Practice Address - Fax:925-691-6434
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62613174400000X
CARHL1314052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G626133OtherMEDICARE PIN FOR CHW WOODLAND
CAD14840Medicare UPIN
CA300091144Medicare ID - Type Unspecified
CA00G626133OtherMEDICARE PIN FOR CHW WOODLAND