Provider Demographics
NPI:1821090119
Name:GRYGIER, DAVID MARK (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MARK
Last Name:GRYGIER
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 1:24 PARK ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4037
Mailing Address - Country:US
Mailing Address - Phone:413-499-6600
Mailing Address - Fax:
Practice Address - Street 1:24 PARK ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4037
Practice Address - Country:US
Practice Address - Phone:413-499-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2017-05-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
MA795212081P2900X
CT0508352081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001508357Medicaid
MAJ14574OtherBLUE CROSS/BLUE SHIELD
MAF81051Medicare UPIN
CTD400068785 - C00814Medicare PIN
CTD400068784 - C00023Medicare PIN
CTD400068785 - C00814Medicare PIN