Provider Demographics
NPI:1538122312
Name:WILLIAMS, MEREDITH MINTO (MD)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:MINTO
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 RAYLOC DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21750-1518
Mailing Address - Country:US
Mailing Address - Phone:301-678-5187
Mailing Address - Fax:301-678-5797
Practice Address - Street 1:130 W HIGH ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MD
Practice Address - Zip Code:21750-1143
Practice Address - Country:US
Practice Address - Phone:301-678-7256
Practice Address - Fax:301-678-6396
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033525208000000X
PAMD035262E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538122312OtherNPI
MD482501200Medicaid
PA1007288800006Medicaid