Provider Demographics
NPI:1588774368
Name:WILLIAMS, NEVILLE W N (MD)
Entity type:Individual
Prefix:DR
First Name:NEVILLE
Middle Name:W N
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10 CONGRESS ST
Mailing Address - Street 2:SUITE210
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3027
Mailing Address - Country:US
Mailing Address - Phone:626-577-8640
Mailing Address - Fax:626-577-6502
Practice Address - Street 1:10 CONGRESS ST
Practice Address - Street 2:SUITE210
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3045
Practice Address - Country:US
Practice Address - Phone:626-577-8640
Practice Address - Fax:626-577-6502
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2017-01-26
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Provider Licenses
StateLicense IDTaxonomies
CAA34071208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A34071Medicaid
CA00A34071Medicaid
A34071Medicare PIN