Provider Demographics
NPI:1184684078
Name:GAINES, WILLIAM M (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:GAINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NEPONSET ST FL ST2
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-368-5532
Mailing Address - Fax:508-832-0859
Practice Address - Street 1:385 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-2498
Practice Address - Country:US
Practice Address - Phone:508-721-1170
Practice Address - Fax:508-832-0859
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7401287OtherAETNA US HEALTHCARE
9900247OtherFALLON COMMUNITY HEALTH P
042472266OtherONE HEALTH PLAN
MA3018598Medicaid
AA1298OtherHARVARD PILGRIM HEALTHCAR
J06139OtherBLUE SHIELD HMO BLUE
J06139OtherBLUE SHIELD INDEMNITY
042472266OtherHEALTHCARE VALUE MGMT
0400948OtherEVERCARE
26819OtherHEALTHY START
4290501OtherCIGNA HEALTH PLAN
784135OtherMVP HEALTH CARE
J06139OtherBLUE CARE ELECT
042472266OtherPRIVATE HEALTHCARE SYSTEM
1060231OtherFIRST HEALTH
26819OtherCHILDRENS MED SEC PLAN
110175376OtherRAILROAD MEDICARE
J06139OtherMEDICARE B
0400948OtherEVERCARE
A58826Medicare UPIN