Provider Demographics
NPI:1811074685
Name:WIENER, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:WIENER
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 1:463 WORCESTER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5356
Mailing Address - Country:US
Mailing Address - Phone:508-879-0014
Mailing Address - Fax:508-626-1985
Practice Address - Street 1:463 WORCESTER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5356
Practice Address - Country:US
Practice Address - Phone:508-879-0014
Practice Address - Fax:508-626-1985
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA255132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2000000146OtherHARVARD PILGRIM HEALTH PL
MA2002329Medicaid
MA23972OtherFALLON
MA703092OtherTUFTS HEALTH PLAN
MAC04357Medicare UPIN
MAA37665Medicare UPIN