Provider Demographics
NPI:1083683130
Name:SPRUIELL, GRAHAM L (MD)
Entity Type:Individual
Prefix:
First Name:GRAHAM
Middle Name:L
Last Name:SPRUIELL
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:VALLEY REGIONAL MEDICAL SERVICES
Mailing Address - Street 2:P.O. BOX 414060
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-0001
Mailing Address - Country:US
Mailing Address - Phone:617-562-5460
Mailing Address - Fax:617-562-5480
Practice Address - Street 1:VALLEY REGIONAL MEDICAL SERVICES
Practice Address - Street 2:70 EAST STREET
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844
Practice Address - Country:US
Practice Address - Phone:978-688-0773
Practice Address - Fax:978-681-6173
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA521922084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA30201318Medicaid
MAE38024Medicare UPIN
MA30201318Medicaid