Provider Demographics
NPI:1245205053
Name:GRUSH, LYNN RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:RUTH
Last Name:GRUSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 CENTRE ST STE 204
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2453
Mailing Address - Country:US
Mailing Address - Phone:617-795-7130
Mailing Address - Fax:617-795-0953
Practice Address - Street 1:1340 CENTRE ST
Practice Address - Street 2:STE 204
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-795-7130
Practice Address - Fax:617-795-0953
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA766312084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3182509Medicaid
MAJ19237OtherBCBS MA
MA760741OtherTUFTS HEALTH PLAN
G76888Medicare UPIN
MAA28719Medicare ID - Type Unspecified