Provider Demographics
NPI:1326096371
Name:DEGROOT, PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:DEGROOT
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 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-654-7280
Mailing Address - Fax:617-654-7363
Practice Address - Street 1:147 MILK ST
Practice Address - Street 2:PROVIDER ENROLLMENT 9TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-4806
Practice Address - Country:US
Practice Address - Phone:617-654-7280
Practice Address - Fax:617-654-7363
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79172207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3187926Medicaid
MAG400OtherHARVARD PILGRIM
MA1591495-002OtherCIGNA
MA0014811OtherNEIGHBORHOOD HEALTH PLAN
MA079172OtherTUFTS HEALTH PLAN
MAJ30762OtherBLUE CROSS
MAJ30762OtherBLUE CROSS
MAJ30762Medicare PIN