Healthcare Provider Details

I. General information

NPI: 1477554624
Provider Name (Legal Business Name): MARK STANLEY WILLIAMS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 LOWS RD
BLOOMSBURG PA
17815-8729
US

IV. Provider business mailing address

6850 LOWS ROAD
BLOOMSBURG PA
17815
US

V. Phone/Fax

Practice location:
  • Phone: 570-784-7300
  • Fax: 570-784-7331
Mailing address:
  • Phone: 570-784-7300
  • Fax: 570-784-7331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number05008141L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: