Provider Demographics
NPI:1770753790
Name:FREDERICK A GRASSIN, D.O.
Entity type:Organization
Organization Name:FREDERICK A GRASSIN, D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRASSIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-849-5445
Mailing Address - Street 1:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34656-0846
Mailing Address - Country:US
Mailing Address - Phone:727-849-5445
Mailing Address - Fax:727-842-6863
Practice Address - Street 1:5901 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2713
Practice Address - Country:US
Practice Address - Phone:727-849-5445
Practice Address - Fax:727-842-6863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS1108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1289Medicare PIN