Provider Demographics
NPI:1265431134
Name:GROBLEWSKI, THOMAS A (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:GROBLEWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3943
Mailing Address - Country:US
Mailing Address - Phone:978-778-0285
Mailing Address - Fax:
Practice Address - Street 1:38 HAYES AVE
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3943
Practice Address - Country:US
Practice Address - Phone:978-969-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3203255Medicaid
MAG86549Medicare UPIN
MAA29151Medicare ID - Type Unspecified