Basic Information
| Provider Information | |||||||||
| NPI: | 1861649642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | EDWIN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6776 SNOW HILL RD | ||||||||
| Address2: | |||||||||
| City: | SNOW HILL | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218633304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106321263 | ||||||||
| FaxNumber: | 4106291505 | ||||||||
| Practice Location | |||||||||
| Address1: | 9714 HEALTHWAY DR # DRL | ||||||||
| Address2: | |||||||||
| City: | BERLIN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218111154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106413340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2008 | ||||||||
| LastUpdateDate: | 09/07/2011 | ||||||||
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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 | 363AM0700X | C0003723 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.