Provider Demographics
NPI:1770530255
Name:MICHAEL J. GROSSMAN M.D. P.C.
Entity type:Organization
Organization Name:MICHAEL J. GROSSMAN M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-682-2121
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-0006
Mailing Address - Country:US
Mailing Address - Phone:603-673-9411
Mailing Address - Fax:603-673-9899
Practice Address - Street 1:565 TURNPIKE ST
Practice Address - Street 2:SUITE 74
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5922
Practice Address - Country:US
Practice Address - Phone:978-682-2121
Practice Address - Fax:978-686-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0018819OtherNEIGHBORHOOD HEALTH
MA7928OtherFALLON COMMUNITY HEALTH
MAM17195OtherBLUE CROSS BLUE SHIELD
MA9706577Medicaid