Provider Demographics
NPI:1164549341
Name:WILLIAMS, ANN-MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4292
Mailing Address - Country:US
Mailing Address - Phone:203-576-6000
Mailing Address - Fax:
Practice Address - Street 1:595 STRAITS TPKE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-3393
Practice Address - Country:US
Practice Address - Phone:844-482-7285
Practice Address - Fax:203-502-2615
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002034363AS0400X
CT2034363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG400003157Medicare PIN