Provider Demographics
NPI:1053350868
Name:BINGHAM, WILLIAM A (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:BINGHAM
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 1:170 WORCESTER ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5506
Mailing Address - Country:US
Mailing Address - Phone:781-431-1333
Mailing Address - Fax:781-431-1933
Practice Address - Street 1:170 WORCESTER ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5506
Practice Address - Country:US
Practice Address - Phone:781-431-1333
Practice Address - Fax:781-431-1933
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA71496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA710840OtherHARVARD PILGRIM
MAJ09837OtherBCBS OF MA
MA071496OtherTUFTS HEALTH PLAN
MA0101389OtherUNITED HEALTH CARE
MAB10426801OtherCIGNA
MA0101389OtherUNITED HEALTH CARE
MA071496OtherTUFTS HEALTH PLAN