Provider Demographics
NPI:1932989696
Name:PARKER, WILLIAM GRANT (PA-S)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GRANT
Last Name:PARKER
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:GRANT
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:179 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5804
Mailing Address - Country:US
Mailing Address - Phone:617-732-2850
Mailing Address - Fax:
Practice Address - Street 1:179 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5804
Practice Address - Country:US
Practice Address - Phone:617-732-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant