Basic Information
| Provider Information | |||||||||
| NPI: | 1821484163 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2509 PLEASANT RUN DR | ||||||||
| Address2: | |||||||||
| City: | ROCKINGHAM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228018720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406895500 | ||||||||
| FaxNumber: | 7574317116 | ||||||||
| Practice Location | |||||||||
| Address1: | 2509 PLEASANT RUN DR | ||||||||
| Address2: | |||||||||
| City: | ROCKINGHAM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228018720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406895500 | ||||||||
| FaxNumber: | 7574317116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2015 | ||||||||
| LastUpdateDate: | 07/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 04750 | KY | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 0102206634 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1821484163 | 05 | VA | MEDICAID | 7100688460 | 05 | KY | MEDICAID | 300041818 | 05 | IN | MEDICAID |