Healthcare Provider Details

I. General information

NPI: 1053546408
Provider Name (Legal Business Name): MARY ELIZABETH WILLIAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8260 ATLEE RD
MECHANICSVILLE VA
23116-1844
US

IV. Provider business mailing address

2620 HANOVER RD
ROCKVILLE VA
23146-2007
US

V. Phone/Fax

Practice location:
  • Phone: 804-569-7007
  • Fax: 804-764-6562
Mailing address:
  • Phone: 804-749-8967
  • Fax: 804-749-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6937
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00519400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110840819
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: