Provider Demographics
NPI:1750411104
Name:NEWTON WELLESLEY PRIMARY CARE
Entity type:Organization
Organization Name:NEWTON WELLESLEY PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOLGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-964-9070
Mailing Address - Street 1:1450 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2690
Mailing Address - Country:US
Mailing Address - Phone:781-449-0020
Mailing Address - Fax:
Practice Address - Street 1:1450 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2690
Practice Address - Country:US
Practice Address - Phone:781-449-0020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM16646OtherBLUE CROSS BLUE SHIELD
MAM16646OtherBLUE CROSS BLUE SHIELD