Healthcare Provider Details

I. General information

NPI: 1629459722
Provider Name (Legal Business Name): DANIELLE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S COLLEGEVILLE RD
COLLEGEVILLE PA
19426-2957
US

IV. Provider business mailing address

5800 WALNUT STREET, REAR
PHILADELPHIA PA
19139
US

V. Phone/Fax

Practice location:
  • Phone: 484-902-1893
  • Fax:
Mailing address:
  • Phone: 215-474-4444
  • Fax: 215-474-6021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT208323
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD464054
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: