Provider Demographics
NPI:1184690992
Name:GROUSSIS, GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:GROUSSIS
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 1:140 W BOYLSTON DR
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2726
Mailing Address - Country:US
Mailing Address - Phone:508-756-9200
Mailing Address - Fax:508-756-9277
Practice Address - Street 1:140 W BOYLSTON DR
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2726
Practice Address - Country:US
Practice Address - Phone:508-756-9200
Practice Address - Fax:508-756-9277
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3152707Medicaid
MAJ16645OtherBCBS
MA081987OtherTUFTS
MD28867OtherFALLON
MD68567OtherHARVARD PILGRIM
MAA21618Medicare ID - Type Unspecified
MAJ16645OtherBCBS