Provider Demographics
NPI:1801887849
Name:PROUTY, W ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:W
Middle Name:ROBERT
Last Name:PROUTY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:75 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-9147
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:781-681-9901
Practice Address - Street 1:75 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-9147
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:781-681-9901
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA30159208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042297845OtherDOC FIRST
4218630OtherAETNA
MA042297845OtherHCVM
MA042297845OtherGIC UNICARE
030159OtherTUFTS
MA042297845OtherTRICARE
MA1801887849Medicaid
20882OtherHARVARD PILGRIM
MA042297845OtherGREAT WEST HEALTH CARE
1801887849OtherFALLON
B10381301OtherCIGNA
MA042297845OtherPRIVATE HEALTHCARE SYSTEM
MA042297845OtherUNITED HEALTH CARE
MA1801887849OtherMEDICARE