Provider Demographics
NPI:1659649440
Name:NEVILLE W.N. WILLIAMS MD INC
Entity type:Organization
Organization Name:NEVILLE W.N. WILLIAMS MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:W N
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-577-8640
Mailing Address - Street 1:10 CONGRESS ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3045
Mailing Address - Country:US
Mailing Address - Phone:626-577-8640
Mailing Address - Fax:626-577-6502
Practice Address - Street 1:10 CONGRESS ST
Practice Address - Street 2:SUITE 210
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3045
Practice Address - Country:US
Practice Address - Phone:626-577-8640
Practice Address - Fax:626-577-6502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34071208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A34071Medicaid
COA34071Medicare PIN
CA00A34071Medicaid