1730158874 NPI number — DR. N WYNTA WILLIAMS DPM

Table of content: DR. N WYNTA WILLIAMS DPM (NPI 1730158874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730158874 NPI number — DR. N WYNTA WILLIAMS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
N
Provider Middle Name:
WYNTA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
N
Provider Other Middle Name:
WYNTA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1730158874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STEVENSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21153-0101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-628-8272
Provider Business Mailing Address Fax Number:
833-764-5719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 BATTLEFIELD BLVD N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-4735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-333-8411
Provider Business Practice Location Address Fax Number:
833-764-5719
Provider Enumeration Date:
03/14/2006

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: 213ES0131X , with the licence number:  0103000797 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5180770002 . This is a "DMERC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 292614 . This is a "MDIPA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 480032523 . This is a "RR MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5180770001 . This is a "DMERC" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 45494 . This is a "OPTIMA HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9300953 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 235919 . This is a "ANTHEM BLUE SHIELD BLUE C" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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