Provider Demographics
NPI:1750585725
Name:GRASSO, ADAM W (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:W
Last Name:GRASSO
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 1:34 HOPKINS POINT LN
Mailing Address - Street 2:
Mailing Address - City:SURRY
Mailing Address - State:ME
Mailing Address - Zip Code:04684-3868
Mailing Address - Country:US
Mailing Address - Phone:216-978-0094
Mailing Address - Fax:
Practice Address - Street 1:50 UNION ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1534
Practice Address - Country:US
Practice Address - Phone:207-634-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35089668207RC0000X
MEMD21359208M00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2749191Medicaid
OHGR7372001Medicare PIN