Basic Information
| Provider Information | |||||||||
| NPI: | 1801887849 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PROUTY | ||||||||
| FirstName: | W | ||||||||
| MiddleName: | ROBERT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 75 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020619147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | 7816819901 | ||||||||
| Practice Location | |||||||||
| Address1: | 75 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | NORWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020619147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7818785200 | ||||||||
| FaxNumber: | 7816819901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 01/03/2011 | ||||||||
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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 | 208000000X | 30159 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 042297845 | 01 | MA | DOC FIRST | OTHER | 4218630 | 01 | AETNA | OTHER | 042297845 | 01 | MA | HCVM | OTHER | 042297845 | 01 | MA | GIC UNICARE | OTHER | 030159 | 01 | TUFTS | OTHER | 042297845 | 01 | MA | TRICARE | OTHER | 1801887849 | 05 | MA | MEDICAID | 20882 | 01 | HARVARD PILGRIM | OTHER | 042297845 | 01 | MA | GREAT WEST HEALTH CARE | OTHER | 1801887849 | 01 | FALLON | OTHER | B10381301 | 01 | CIGNA | OTHER | 042297845 | 01 | MA | PRIVATE HEALTHCARE SYSTEM | OTHER | 042297845 | 01 | MA | UNITED HEALTH CARE | OTHER | 1801887849 | 01 | MA | MEDICARE | OTHER |