Provider Demographics
NPI:1861453391
Name:GRUVER, E JAMES III (MD)
Entity Type:Individual
Prefix:
First Name:E
Middle Name:JAMES
Last Name:GRUVER
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 1:7 TANGLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2615
Mailing Address - Country:US
Mailing Address - Phone:781-235-5579
Mailing Address - Fax:781-235-5579
Practice Address - Street 1:55 FOGG RD
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2432
Practice Address - Country:US
Practice Address - Phone:781-340-8338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-02
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81065208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3188850Medicaid
MAG87571Medicare UPIN