Provider Demographics
NPI:1710082672
Name:JONES, GRENVILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:GRENVILLE
Middle Name:
Last Name:JONES
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:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04903-0608
Mailing Address - Country:US
Mailing Address - Phone:207-873-6034
Mailing Address - Fax:207-872-9136
Practice Address - Street 1:361 OLD BELGRADE RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8058
Practice Address - Country:US
Practice Address - Phone:207-873-6034
Practice Address - Fax:207-872-9136
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0152802085R0203X
MA2422042085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME038732OtherBCBS
MA305950099Medicaid
MAMM8492OtherMEDICARE
MAMM8492OtherMEDICARE