=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225134299
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEROY WILLIAMS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | VAMC 50 IRVING ST NW RADIOLOGY SERVICE
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20422-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-745-8000
-----------------------------------------------------
Fax | 202-745-2269
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12719 AUTUMN CREST DR
-----------------------------------------------------
City | OAK HILL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20171-1938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-745-8000
-----------------------------------------------------
Fax | 202-745-2269
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | MD20694
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------