Provider Demographics
NPI:1801865662
Name:GROTZ, RICHARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:GROTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1350 BELMONT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4430
Mailing Address - Country:US
Mailing Address - Phone:774-776-2991
Mailing Address - Fax:774-776-2996
Practice Address - Street 1:1 PEARL ST
Practice Address - Street 2:SUITE 2700
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2864
Practice Address - Country:US
Practice Address - Phone:508-584-4104
Practice Address - Fax:508-584-4105
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2016-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA77137208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP00092280OtherRR MEDICARE
MA14-00003OtherUNITED HEALTHCARE
MA300852540OtherHEALTHNET
MA0013819OtherNEIGHBORHOOD HEALTH
MA29256OtherHARVARD PILGRIM
MA3109950Medicaid
MA77137OtherTUFTS PROV#
MAGRJ13652OtherBLUE CROSS BLUE SHIELD
MA454450OtherAETNA HEALTHCARE
MAJ13652Medicare ID - Type UnspecifiedMEDICARE PROV#
MA3109950Medicaid