Individual
MRS. PAMELA GRANVILLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
300 LONGWOOD AVE, OTOLARYNGOLOGY DEPARTMENT, BOSTON, MA 02115-5724
(617) 355-6460
Mailing address
300 LONGWOOD AVE, OTOLARYNGOLOGY DEPARTMENT, BOSTON, MA 02115
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA4292
—
363AS0400X
Surgical Physician Assistant
Primary
301719
MA
Other
Enumeration date
12/08/2011
Last updated
08/22/2019
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