Healthcare Provider Details

I. General information

NPI: 1700041118
Provider Name (Legal Business Name): EMOLIERE CHANEL WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 WASHINGTON BLVD # 103 STAMFORD HEALTH INTEGRATED PRACTICES INC.
STAMFORD CT
06902-2451
US

IV. Provider business mailing address

4600 MAIN ST
BRIDGEPORT CT
06606-1839
US

V. Phone/Fax

Practice location:
  • Phone: 203-348-2937
  • Fax: 203-348-1968
Mailing address:
  • Phone: 203-371-4445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number049041
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: