Provider Demographics
NPI:1134372584
Name:WILLIAMS, ZACHARY R (MD)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 EXCHANGE BLVD APT 330
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14608-2780
Mailing Address - Country:US
Mailing Address - Phone:801-581-2401
Mailing Address - Fax:
Practice Address - Street 1:310 EXCHANGE BLVD APT 330
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14608-2780
Practice Address - Country:US
Practice Address - Phone:801-455-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7154790-1205207R00000X
NY258290207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03352949Medicaid
NY03352949Medicaid
NY70005AMedicare PIN