Provider Demographics
NPI:1215920186
Name:WILLIAMS, MARK S (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 EVERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1512
Mailing Address - Country:US
Mailing Address - Phone:724-887-4550
Mailing Address - Fax:724-887-7485
Practice Address - Street 1:305 EVERSON AVE
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-1512
Practice Address - Country:US
Practice Address - Phone:724-887-4550
Practice Address - Fax:724-887-7485
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005170L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009761700002Medicaid
PA080006831OtherTRAVELERS MEDICARE
PA0009761700002Medicaid
PA080006831OtherTRAVELERS MEDICARE