Provider Demographics
NPI:1932177268
Name:WILLIAMS, PERRY SWINTZ (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:SWINTZ
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:PO BOX 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:803 W MARKET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2796
Practice Address - Country:US
Practice Address - Phone:419-996-5063
Practice Address - Fax:419-996-5502
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA25MA072982002085R0001X
NY18279812085R0001X
OH351256812085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0127134Medicaid
NJ8880603Medicaid
OH0127134Medicaid
NJ102498Medicare PIN