Provider Demographics
NPI:1649269531
Name:AUSTEN, WILLIAM GERALD JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GERALD
Last Name:AUSTEN
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:15 PARKMAN STREET
Mailing Address - Street 2:WACC 435
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3117
Mailing Address - Country:US
Mailing Address - Phone:617-724-9922
Mailing Address - Fax:617-726-8089
Practice Address - Street 1:15 PARKMAN STREET
Practice Address - Street 2:WACC 435
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-724-9922
Practice Address - Fax:617-726-8089
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2009-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA153973208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3191125Medicaid
RIWA49549OtherOSW-RHODE ISLAND #
NH11853400OtherHEALTHSOURCE NEW HAMPSHIR
MA13-00204OtherUNITED HEALTH CARE #
MA21697OtherHARVARD PILGRIM #
MA3143599OtherAETNA PROVIDER NUMBER
MA0029054OtherNEIGHBORHOOD HEALTH PLAN
MAJ19220OtherBLUE CROSS BLUE SHIELD #
NH30204972Medicaid
MA797462OtherTUFTS HEALTH PLAN
NH11853OtherNEW HAMPSHIRE VENDOR #
MA7478597001OtherCIGNA PROVIDER NUMBER
NH30204972Medicaid
MA13-00204OtherUNITED HEALTH CARE #
MA21697OtherHARVARD PILGRIM #