Provider Demographics
NPI:1134147614
Name:WILLIAMS, GAIL (LDN)
Entity type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 N BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1148
Mailing Address - Country:US
Mailing Address - Phone:508-350-2350
Mailing Address - Fax:508-350-2318
Practice Address - Street 1:1 COMPASS WAY
Practice Address - Street 2:SUITE 208
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1465
Practice Address - Country:US
Practice Address - Phone:508-350-2222
Practice Address - Fax:508-350-2316
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA766133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMX3109OtherMEDICARE PTAN
MAMX3109OtherMEDICARE PTAN
MAMT0150Medicare ID - Type Unspecified