Provider Demographics
NPI:1144418328
Name:WILLIE J. CATER, M.D. P.C.
Entity Type:Organization
Organization Name:WILLIE J. CATER, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CELLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-410-9111
Mailing Address - Street 1:PO BOX 55849
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02205-5849
Mailing Address - Country:US
Mailing Address - Phone:617-296-6622
Mailing Address - Fax:617-296-4827
Practice Address - Street 1:2110 DORCHESTER AVE
Practice Address - Street 2:SETON MEDICAL OFFICE BLDG, SUITE 211
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5628
Practice Address - Country:US
Practice Address - Phone:617-296-6622
Practice Address - Fax:617-296-4827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34911207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9724613Medicaid
MA9724613Medicaid