Healthcare Provider Details

I. General information

NPI: 1972594349
Provider Name (Legal Business Name): GARY A WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 LIBERTY ST
SCHENECTADY NY
12305-2014
US

IV. Provider business mailing address

121 EVERETT RD
ALBANY NY
12205-1447
US

V. Phone/Fax

Practice location:
  • Phone: 518-382-7200
  • Fax: 518-382-7205
Mailing address:
  • Phone: 518-453-9088
  • Fax: 518-689-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number112976
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number112976
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number112976
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number112976
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: