1841307360 NPI number — WILLIAMSON MEDICAL PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841307360 NPI number — WILLIAMSON MEDICAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAMSON MEDICAL PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841307360
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4418 RIDGE RD E
Provider Second Line Business Mailing Address:
WILLAMSON MEDICAL PLLC
Provider Business Mailing Address City Name:
WILLIAMSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-589-4641
Provider Business Mailing Address Fax Number:
315-589-9585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4418 RIDGE RD E
Provider Second Line Business Practice Location Address:
WILLAMSON MEDICAL PLLC
Provider Business Practice Location Address City Name:
WILLIAMSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-589-4641
Provider Business Practice Location Address Fax Number:
315-589-9585
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PERSAUD
Authorized Official First Name:
KRISHNA
Authorized Official Middle Name:
V
Authorized Official Title or Position:
OWNER MD
Authorized Official Telephone Number:
315-589-4641

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G0180451260 . This is a "BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02329519 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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