Provider Demographics
NPI:1043288848
Name:WILLIAMS, GREGORY T (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-3122
Mailing Address - Fax:508-368-3121
Practice Address - Street 1:123 SUMMER STREET
Practice Address - Street 2:SUITE 220 S
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-368-3122
Practice Address - Fax:508-368-3121
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79617207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA2844OtherHARVARD PILGRIM HEALTHCAR
J14908OtherBLUE SHIELD IDEMNITY
J14908OtherBLUE SHIELD HMO BLUE
042472266OtherHEALTHCARE VALUE MANAGEME
MA3130711Medicaid
784106OtherMVP HEALTH CARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
1061518OtherFIRST HEALTH
26881OtherHEALTHY START
042472266OtherONE HEALTH PLAN
J14908OtherBLUE CARE ELECT
26881OtherCHILDRENS MEDICAL SECURIT
5218590OtherCIGNA HEALTH PLAN
91119OtherFALLON COMMUNITY HEALTH P
5237703OtherAETNA US HEALTHCARE
9200061OtherEVERCARE
J14908OtherBLUE CARE ELECT
26881OtherCHILDRENS MEDICAL SECURIT
1061518OtherFIRST HEALTH
110147355Medicare ID - Type UnspecifiedRAILROAD MEDICARE