Provider Demographics
NPI:1124319801
Name:WILLIAMS, BERKLEY LEO (PA-C)
Entity type:Individual
Prefix:MR
First Name:BERKLEY
Middle Name:LEO
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 SUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4405
Mailing Address - Country:US
Mailing Address - Phone:703-530-1226
Mailing Address - Fax:703-530-1228
Practice Address - Street 1:8708 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4405
Practice Address - Country:US
Practice Address - Phone:703-530-1226
Practice Address - Fax:703-530-1228
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840786363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical