Provider Demographics
NPI:1205885761
Name:GRISWOLD, JONATHAN DEWITT (MD,MS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DEWITT
Last Name:GRISWOLD
Suffix:
Gender:M
Credentials:MD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF ANESTHESIOLOGY, BOX 298
Mailing Address - Street 2:T-NEMC, 750 WASHINGTON ST.
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-6044
Mailing Address - Fax:
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:DEPARTMENT OF ANESTHESIA, NEW ENGLAND MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-0081
Practice Address - Fax:617-636-8384
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53973207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3027716Medicaid
MAJO6874Medicare ID - Type Unspecified
MA3027716Medicaid