Provider Demographics
NPI:1992774723
Name:MCRAE, SIMON N (MD)
Entity type:Individual
Prefix:
First Name:SIMON
Middle Name:N
Last Name:MCRAE
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 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-368-3183
Mailing Address - Fax:508-368-3193
Practice Address - Street 1:123 SUMMER ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:508-368-3183
Practice Address - Fax:508-368-3193
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209442208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1900334OtherEVERCARE
62203OtherCHILDRENS MEDICAL SECURIT
042472266OtherPRIVATE HEALTHCARE SYSTEM
042472266OtherTHREE RIVERS
51979OtherFALLON COMMUNITY HEALTH P
62203OtherHEALTHY START
042472266OtherONE HEALTH PLAN
784051OtherMVP HEALTH CARE
7501279OtherAETNA US HEALTHCARE
J23861OtherBLUE SHIELD INDEMNITY
MA0144401Medicaid
J23861OtherBLUE CARE ELECT
J23861OtherBLUE SHIELD HMO BLUE
209442OtherTUFTS HEALTH PLAN
AA13997OtherHARVARD PILGRIM HEALTHCAR
0144401OtherMEDICAID WELFARE
4865766OtherCIGNA HEALTH PLAN
7501279OtherAETNA US HEALTHCARE
784051OtherMVP HEALTH CARE
MA0144401Medicaid