Provider Demographics
NPI:1326174574
Name:GROVER, ALISON WHITNEY (MD, MPH)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:WHITNEY
Last Name:GROVER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:80 PHOENIX AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-1418
Mailing Address - Country:US
Mailing Address - Phone:203-756-8021
Mailing Address - Fax:203-596-9038
Practice Address - Street 1:101 WASON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1140
Practice Address - Country:US
Practice Address - Phone:774-317-6200
Practice Address - Fax:774-317-6206
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031718207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT031718OtherLICENSE
CT001317181Medicaid
54760OtherMASSACHUSSETTS LICENSE
54760OtherMASSACHUSSETTS LICENSE
CT031718OtherLICENSE