Provider Demographics
NPI:1134196686
Name:GRANDE, DONALD J (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:J
Last Name:GRANDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 MAIN ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-3301
Mailing Address - Country:US
Mailing Address - Phone:781-371-7010
Mailing Address - Fax:978-371-0522
Practice Address - Street 1:92 MONTVALE AVE STE 3000
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3658
Practice Address - Country:US
Practice Address - Phone:781-438-6350
Practice Address - Fax:781-395-4806
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15753207N00000X, 207ND0101X
MA37135174400000X, 207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0164186Medicaid
MA0164186Medicaid
MAB53087Medicare ID - Type Unspecified