Provider Demographics
NPI:1417932450
Name:WILLERS, HENNING (MD)
Entity Type:Individual
Prefix:DR
First Name:HENNING
Middle Name:
Last Name:WILLERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:88 EAST NEWTON ST
Practice Address - Street 2:EB 11 BOSTON MEDICAL CENTER RADIATION ONCOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118
Practice Address - Country:US
Practice Address - Phone:617-638-7070
Practice Address - Fax:617-638-7037
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2012-08-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2057882085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2100576Medicaid
MA468157OtherTUFTS HEALTH PLAN
MAJ28557OtherBCBS MA
MA468157OtherTUFTS HEALTH PLAN
MA2100576Medicaid