Provider Demographics
NPI:1568414977
Name:GROSSMAN, NEIL (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:GROSSMAN
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 1:91 STILES RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2846
Mailing Address - Country:US
Mailing Address - Phone:603-890-4404
Mailing Address - Fax:603-893-8886
Practice Address - Street 1:366 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6206
Practice Address - Country:US
Practice Address - Phone:781-239-0033
Practice Address - Fax:781-237-8938
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA445092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6164099Medicaid
A56341Medicare UPIN
MA6164099Medicaid