MEDICARE: DR. MARY A WILLIAMSON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247ZC0005X	Clinical Laboratory Director (Non-physician)	WILLM7	NY

General Provider Information

NPI Number	:	1225402894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY A WILLIAMSON PHD

Provider Business Mailing Address
First Line	:	335 STONE FENCE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-3186
Country	:	US
Telephone Number	:	585-429-2226
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 ELMGROVE PARK
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14624-1359
Country	:	US
Telephone Number	:	585-429-2226
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	11/19/2015

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