Provider Demographics
NPI:1316942675
Name:WILLIAMSON, ROBERT VAN (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:VAN
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1267
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:NC
Mailing Address - Zip Code:27030-1267
Mailing Address - Country:US
Mailing Address - Phone:336-786-4522
Mailing Address - Fax:336-789-3025
Practice Address - Street 1:314 S SOUTH ST STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:NC
Practice Address - Zip Code:27030
Practice Address - Country:US
Practice Address - Phone:336-719-0011
Practice Address - Fax:336-719-0714
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00597207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2039776Medicare PIN
NCI29607Medicare UPIN
NC2039776Medicare ID - Type Unspecified