1265442511 NPI number — EDWARD J WILLIAMS MD

Table of content: EDWARD J WILLIAMS MD (NPI 1265442511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265442511 NPI number — EDWARD J WILLIAMS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
EDWARD
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1265442511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 LAFAYETTE RD
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03842-3344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-926-0088
Provider Business Mailing Address Fax Number:
603-926-2853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
789 CENTRAL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03820-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-740-2163
Provider Business Practice Location Address Fax Number:
603-740-2246
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  9848 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 930055338 . This is a "RAILROAD THRU SEACOAST ER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 0119415 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 310930099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0106314T0NH01 . This is a "BCBS THRU SEACOAST ER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30010456 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: G04017 . This is a "HARVARD PILGRIM NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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