Provider Demographics
NPI:1164955910
Name:GROVER, AMIT JOHNNY (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:JOHNNY
Last Name:GROVER
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 1:200 COPELAND DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1225
Mailing Address - Country:US
Mailing Address - Phone:508-339-4144
Mailing Address - Fax:
Practice Address - Street 1:200 COPELAND DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1225
Practice Address - Country:US
Practice Address - Phone:508-618-2175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-08
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61816207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine