Basic Information
| Provider Information | |||||||||
| NPI: | 1215927389 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUPTILL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 690 CANTON STREET | ||||||||
| Address2: | SUITE 325 | ||||||||
| City: | WESTWOOD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020902329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814077713 | ||||||||
| FaxNumber: | 7814070998 | ||||||||
| Practice Location | |||||||||
| Address1: | 795 MIDDLE STREET | ||||||||
| Address2: | |||||||||
| City: | FALL RIVER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027211733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5086745600 | ||||||||
| FaxNumber: | 5086755671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2005 | ||||||||
| LastUpdateDate: | 12/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 155482 | MA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 155482 | MA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | 155482 | MA | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3183173 | 05 | MA | MEDICAID |