Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD019351E | PA |
Y | 111NI0900X | Internist | MD019351E | PA |
N | 207RG0300X | Geriatric Medicine | MD019351E | PA |
NPI | 1083686216 |
---|---|
Provider Name | Dr. Gregory D Williams |
First Address | Philadelphia, PA 19151-2523 |
Second Address | Philadelphia, PA 19151-2523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 26/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0611722005 | (05) | PA |
C29312 | (02) | PA |