Provider Demographics
NPI:1326018813
Name:GRIEVESON, JOHN N (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:N
Last Name:GRIEVESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:N
Other - Last Name:GRIEVESON-SANTIAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:33 BARTLETT ST STE 204
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1317
Mailing Address - Country:US
Mailing Address - Phone:978-453-0550
Mailing Address - Fax:888-481-1424
Practice Address - Street 1:33 BARTLETT ST STE 204
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1317
Practice Address - Country:US
Practice Address - Phone:978-453-0550
Practice Address - Fax:888-481-1424
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151494207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3159213Medicaid
G36278Medicare UPIN
A21804Medicare ID - Type Unspecified