Provider Demographics
NPI:1679740005
Name:WILLIAMS, MATTHEW LANIER (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LANIER
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 208039
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8039
Mailing Address - Country:US
Mailing Address - Phone:203-785-3883
Mailing Address - Fax:
Practice Address - Street 1:330 CEDAR ST # BB204
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3218
Practice Address - Country:US
Practice Address - Phone:203-785-5000
Practice Address - Fax:203-785-3346
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300106208G00000X
PAMD452931208G00000X
KYTP771208G00000X
CT69392208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY21035Medicare PIN