Healthcare Provider Details

I. General information

NPI: 1679565410
Provider Name (Legal Business Name): EDWIN F WILLIAMS III MD FACIAL PLASTIC SURGERY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 09/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 TROY SCHENECTADY RD
LATHAM NY
12110-1025
US

IV. Provider business mailing address

PO BOX 11716
ALBANY NY
12211-0716
US

V. Phone/Fax

Practice location:
  • Phone: 518-786-7000
  • Fax:
Mailing address:
  • Phone: 518-724-2815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWIN F WILLIAMS III
Title or Position: OWNER
Credential: MD
Phone: 518-724-2815