Provider Demographics
NPI:1194782722
Name:WILLIAMS, DAVID D (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:D
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 1:110 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-6297
Mailing Address - Country:US
Mailing Address - Phone:607-287-8861
Mailing Address - Fax:
Practice Address - Street 1:2212 PENFIELD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1756
Practice Address - Country:US
Practice Address - Phone:585-598-8505
Practice Address - Fax:585-598-8122
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01988247Medicaid
NY01988247Medicaid
NY9X5801Medicare ID - Type UnspecifiedDOWNSTATE
NYJ400064069Medicare PIN