Provider Demographics
NPI:1841300159
Name:WILLIAMS, MARVIN H JR (MD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:H
Last Name:WILLIAMS
Suffix:JR
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 1:1176 E HOME RD
Mailing Address - Street 2:SUITE O
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2726
Mailing Address - Country:US
Mailing Address - Phone:937-398-0051
Mailing Address - Fax:937-398-0054
Practice Address - Street 1:1176 E HOME RD
Practice Address - Street 2:SUITE O
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2726
Practice Address - Country:US
Practice Address - Phone:937-398-0051
Practice Address - Fax:937-398-0054
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-051235207Q00000X
OH35.051235207P00000X
NC9700809207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000335653OtherANTHEM
OH000000544524OtherANTHEM
OH2477181Medicaid
OH4134011Medicare ID - Type Unspecified
OH000000335653OtherANTHEM
OH000000544524OtherANTHEM