Provider Demographics
NPI:1710958723
Name:DEGROOT, HENRY III (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:DEGROOT
Suffix:III
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 1:2000 WASHINGTON ST
Mailing Address - Street 2:SUITE 544
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1650
Mailing Address - Country:US
Mailing Address - Phone:617-796-9922
Mailing Address - Fax:617-796-9923
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 544
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-796-9922
Practice Address - Fax:617-796-9923
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHEL12091207X00000X
MEMD23728207X00000X
DEC1-0024734207X00000X
FLME121606207XX0004X
MAMA79171207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM18032Medicare ID - Type Unspecified
MAF24634Medicare UPIN