Provider Demographics
NPI:1528140647
Name:WILLIAMS, DANIEL A (PA-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
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 1:19465 DEERFIELD AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1707
Mailing Address - Country:US
Mailing Address - Phone:703-858-1800
Mailing Address - Fax:703-858-1801
Practice Address - Street 1:19465 DEERFIELD AVE STE 405
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1707
Practice Address - Country:US
Practice Address - Phone:703-858-1800
Practice Address - Fax:703-858-1801
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA110002527363A00000X
MEPA882363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431870199Medicaid
ME431870199Medicaid