Provider Demographics
NPI:1912772500
Name:WILLIAMS, MARCIA VANESSA
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:VANESSA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 MARKEL RD # NA
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1120
Mailing Address - Country:US
Mailing Address - Phone:484-239-8746
Mailing Address - Fax:
Practice Address - Street 1:533 MARKEL RD # NA
Practice Address - Street 2:
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1120
Practice Address - Country:US
Practice Address - Phone:484-239-8746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-24
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier