Basic Information
| Provider Information | |||||||||
| NPI: | 1598733511 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARKER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784663208 | ||||||||
| FaxNumber: | 9788401680 | ||||||||
| Practice Location | |||||||||
| Address1: | 165 MILL ST | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784663208 | ||||||||
| FaxNumber: | 9788401680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 02/20/2009 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 51115 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 784171 | 01 | MVP HEALTH CARE | OTHER | 9900069 | 01 | FALLON COMMUNITY HEALTH P | OTHER | AA1222 | 01 | HARVARD PILGRIM HEALTH CA | OTHER | 080129481 | 01 | RAILROAD MEDICARE | OTHER | 1150243 | 01 | FRIST HEALTH | OTHER | 7797329 | 01 | AETNA US HEALTHCARE | OTHER | J02366 | 01 | BLUE CARE ELECT | OTHER | J02366 | 01 | BLUE SHIELD INDEMNITY | OTHER | 26923 | 01 | HEALTHY START | OTHER | 0100290 | 01 | EVERCARE | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | 042472266 | 01 | THREE RIVERS | OTHER | 6175538 | 05 | MA | MEDICAID | 0303018 | 01 | CIGNA HEALTH PLAN | OTHER | 042472266 | 01 | HEALTHCARE VALUE MANAGEME | OTHER | 26923 | 01 | CHILDRENS MEDICAL SECURIT | OTHER | J02366 | 01 | BLUE SHIELD HMO BLUE | OTHER |