MEDICARE: DR. N WYNTA WILLIAMS DPM

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	213ES0131X	Foot Surgery Podiatrist	0103000797	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	480032523	OTHER	VA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	5180770001	OTHER	VA	DMERC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	235919	OTHER	VA	ANTHEM BLUE SHIELD BLUE C
5	45494	OTHER	VA	OPTIMA HEALTH
6	292614	OTHER	VA	MDIPA
7	5180770002	OTHER	VA	DMERC

General Provider Information

NPI Number	:	1730158874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. N WYNTA WILLIAMS DPM

Provider Business Mailing Address
First Line	:	4224 HOLLAND RD
Second Line	:	SUITE #106
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1900
Country	:	US
Telephone Number	:	757-498-0202
Fax Number	:	757-498-7936

Provider Business Practice Location Address
First Line	:	4224 HOLLAND RD
Second Line	:	SUITE #106
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1900
Country	:	US
Telephone Number	:	757-498-0202
Fax Number	:	757-498-7936

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	05/09/2012

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Directions to “ DR. N WYNTA WILLIAMS DPM” Practice Location

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