Basic Information
| Provider Information | |||||||||
| NPI: | 1003143488 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 ELDER AVENUE | ||||||||
| Address2: | |||||||||
| City: | LANSDOWNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190503005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106231433 | ||||||||
| FaxNumber: | 6106239678 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 ELDER AVENUE | ||||||||
| Address2: | |||||||||
| City: | LANSDOWNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190503005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106231433 | ||||||||
| FaxNumber: | 6106239678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2009 | ||||||||
| LastUpdateDate: | 03/02/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD039870E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | FW1853604 | 01 | PA | DEA | OTHER |