Provider Demographics
NPI:1134106172
Name:VALLE, GRACE A (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:A
Last Name:VALLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GRACE
Other - Middle Name:A
Other - Last Name:VALLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:63 NATHAN ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-1135
Mailing Address - Country:US
Mailing Address - Phone:617-975-4743
Mailing Address - Fax:617-325-0353
Practice Address - Street 1:63 NATHAN RD
Practice Address - Street 2:
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-1135
Practice Address - Country:US
Practice Address - Phone:617-965-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA366092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA705121OtherTUFTS HEALTH PLAN
B73000Medicare UPIN
MA705121OtherTUFTS HEALTH PLAN