Basic Information
| Provider Information | |||||||||
| NPI: | 1265442511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 540 LAFAYETTE RD | ||||||||
| Address2: | SUITE 8 | ||||||||
| City: | HAMPTON | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038423344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039260088 | ||||||||
| FaxNumber: | 6039262853 | ||||||||
| Practice Location | |||||||||
| Address1: | 789 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038202526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037402163 | ||||||||
| FaxNumber: | 6037402246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 06/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 9848 | NH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 930055338 | 01 | NH | RAILROAD THRU SEACOAST ER | OTHER | 0119415 | 05 | MA | MEDICAID | 310930099 | 05 | ME | MEDICAID | 0106314T0NH01 | 01 | NH | BCBS THRU SEACOAST ER | OTHER | 30010456 | 05 | NH | MEDICAID | G04017 | 01 | NH | HARVARD PILGRIM NH | OTHER |