Healthcare Provider Details

I. General information

NPI: 1992785489
Provider Name (Legal Business Name): IRVING C WILLIAMS II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 LAKE MANASSAS DR #209
GAINESVILLE VA
20155-3258
US

IV. Provider business mailing address

7915 LAKE MANASSAS DR #209
GAINESVILLE VA
20155-3258
US

V. Phone/Fax

Practice location:
  • Phone: 571-248-0679
  • Fax: 571-261-9549
Mailing address:
  • Phone: 571-248-0679
  • Fax: 571-261-9549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101236873
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: