Provider Demographics
NPI:1891786430
Name:PALMER, WILLIAM EWING (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EWING
Last Name:PALMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:49 PINCKNEY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4801
Mailing Address - Country:US
Mailing Address - Phone:617-726-7719
Mailing Address - Fax:617-726-5282
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:MGH YAWKEY 6030 RADIOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-7719
Practice Address - Fax:617-726-5282
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA57282207R00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3080200Medicaid
MA718960OtherTUFTS HEALTH PLAN
MAJ10776OtherBCBS MA
MAJ10776Medicare ID - Type Unspecified
MA3080200Medicaid