Provider Demographics
NPI:1053339283
Name:WILLIAMS-TOONE, DEITRA LETRICE (MD)
Entity type:Individual
Prefix:
First Name:DEITRA
Middle Name:LETRICE
Last Name:WILLIAMS-TOONE
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:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5100
Mailing Address - Country:US
Mailing Address - Phone:919-220-5255
Mailing Address - Fax:
Practice Address - Street 1:1111 HUFFMAN MILL RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8862
Practice Address - Country:US
Practice Address - Phone:336-584-5544
Practice Address - Fax:336-584-4438
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500671207L00000X, 207LP2900X, 208VP0014X
NC2005-00671208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3416947OtherCIGNA
NCP00380380OtherRAILRAOD-MEDICARE
NC808986OtherPARTNERS
NC192193OtherMEDCOST
NC5904964Medicaid
NC143R1OtherBCBS NC
NC192193OtherMEDCOST
NC2057266Medicare PIN