Individual
DR. ANTONIO GRANFONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 BROADWAY RHC, REVERE HEALTH CENTER BROADWAY, REVERE, MA 02151-5035
(781) 485-1000
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(781) 485-1000
(781) 286-5418
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
48781
MA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
48781
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3010261
—
MA
01
—
716085
TUFTS HEALTH PLAN
MA
01
—
J05333
BCBS MA
MA
Enumeration date
02/24/2006
Last updated
11/29/2012
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