Healthcare Provider Details

I. General information

NPI: 1265428221
Provider Name (Legal Business Name): DOUGLAS WILLIAMSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 ALICE PECK DAY DR
LEBANON NH
03766-2901
US

IV. Provider business mailing address

10 ALICE PECK DAY DR
LEBANON NH
03766-2694
US

V. Phone/Fax

Practice location:
  • Phone: 603-448-3122
  • Fax: 603-448-7491
Mailing address:
  • Phone: 603-448-3121
  • Fax: 603-448-7462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9573
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: