Provider Demographics
NPI:1356445829
Name:HOLGERSON, WILLIAM B (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:HOLGERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:40 WALNUT STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2102
Mailing Address - Country:US
Mailing Address - Phone:781-235-1224
Mailing Address - Fax:781-235-4111
Practice Address - Street 1:40 WALNUT STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2102
Practice Address - Country:US
Practice Address - Phone:781-235-1224
Practice Address - Fax:781-235-4111
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2019-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAMA42491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2063905Medicaid
MA4104100003OtherCIGNA
MA445111087OtherRAILROAD MEDICARE
MA61775OtherHARVARD PILGRIM HEALTH
MA04-01896OtherUNITED HEALTHCARE
MA706659OtherTUFTS
MAB33544OtherBLUESHIELD OF MA
MACX8009Medicare PIN
MA4104100003OtherCIGNA