Provider Demographics
NPI:1124041348
Name:GRASS, WILLIAM S (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:GRASS
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 1:118 PINE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-8421
Mailing Address - Country:US
Mailing Address - Phone:802-660-8000
Mailing Address - Fax:802-862-4062
Practice Address - Street 1:118 PINE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-8421
Practice Address - Country:US
Practice Address - Phone:802-660-8000
Practice Address - Fax:802-862-4062
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-00099172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1007917Medicaid
NH30201707Medicaid
VTVN259802Medicare Oscar/Certification
VTH45170Medicare UPIN