Provider Demographics
NPI:1063482602
Name:SEMIGRAN, MARC JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:JAY
Last Name:SEMIGRAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-8862
Mailing Address - Fax:617-726-4105
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GREY BIGELOW 840
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-8862
Practice Address - Fax:617-726-4105
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2014-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA53859207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ04904OtherBCBS MA
MA3044173Medicaid
MA713854OtherTUFTS HEALTH PLAN
A58123Medicare UPIN
MA3044173Medicaid