MEDICARE: MR. IRVING C WILLIAMS II MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0101236873	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992785489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IRVING C WILLIAMS II MD

Provider Business Mailing Address
First Line	:	7915 LAKE MANASSAS DR
Second Line	:	#209
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3258
Country	:	US
Telephone Number	:	571-248-0679
Fax Number	:	571-261-9549

Provider Business Practice Location Address
First Line	:	7915 LAKE MANASSAS DR
Second Line	:	#209
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3258
Country	:	US
Telephone Number	:	571-248-0679
Fax Number	:	571-261-9549

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	05/21/2013

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