Provider Demographics
NPI:1992785489
Name:WILLIAMS, IRVING C II (MD)
Entity type:Individual
Prefix:MR
First Name:IRVING
Middle Name:C
Last Name:WILLIAMS
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:7915 LAKE MANASSAS DR
Mailing Address - Street 2:#209
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3258
Mailing Address - Country:US
Mailing Address - Phone:571-248-0679
Mailing Address - Fax:571-261-9549
Practice Address - Street 1:7915 LAKE MANASSAS DR
Practice Address - Street 2:#209
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3258
Practice Address - Country:US
Practice Address - Phone:571-248-0679
Practice Address - Fax:571-261-9549
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-05-21
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Provider Licenses
StateLicense IDTaxonomies
VA0101236873208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010103592Medicaid