Provider Demographics
NPI:1962492231
Name:PALMER, EDWIN LINCOLN (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:LINCOLN
Last Name:PALMER
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: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:617-726-8782
Mailing Address - Fax:617-726-6165
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:WHT 289 RADIOLOGICAL ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-8782
Practice Address - Fax:617-726-6165
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49988207U00000X, 2085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2087383Medicaid
MA727723OtherTUFTS HEALTH PLAN
MAC15102OtherBCBS MA
B87208Medicare UPIN
MA727723OtherTUFTS HEALTH PLAN