Provider Demographics
NPI:1194753285
Name:WILLIAMS, WILLIAM VALENTINE (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:VALENTINE
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 1:3910 POWELTON AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2692
Mailing Address - Country:US
Mailing Address - Phone:215-662-4333
Mailing Address - Fax:215-349-8900
Practice Address - Street 1:3910 POWELTON AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2692
Practice Address - Country:US
Practice Address - Phone:215-662-4333
Practice Address - Fax:215-349-8900
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD03602E207RR0500X
PAMD036302E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010639540002Medicaid
C30121Medicare UPIN
PA0010639540002Medicaid