Provider Demographics
NPI:1962508655
Name:GROSSMAN, RICHARD SAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SAUL
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 OLE MUSKET RD
Mailing Address - Street 2:UNIT 5
Mailing Address - City:CUMBERLAND FORESIDE
Mailing Address - State:ME
Mailing Address - Zip Code:04110-1422
Mailing Address - Country:US
Mailing Address - Phone:207-400-0142
Mailing Address - Fax:
Practice Address - Street 1:10 OLE MUSKET RD
Practice Address - Street 2:UNIT 5
Practice Address - City:CUMBERLAND FORESIDE
Practice Address - State:ME
Practice Address - Zip Code:04110-1422
Practice Address - Country:US
Practice Address - Phone:207-400-0142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02232108Medicaid
C92775Medicare UPIN
NY02232108Medicaid