Individual
THOMAS JOSEPH GRADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.,
Contact information
Practice address
20 HOPE AVE, STE. 207, WALTHAM, MA 02453-2721
(781) 893-6520
(781) 893-6522
Mailing address
20 HOPE AVE, STE. 207, WALTHAM, MA 02453-2721
(781) 893-6520
(781) 893-6522
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A34515
MA
2086S0129X
Vascular Surgery Physician
34153
MA
208C00000X
Colon & Rectal Surgery Physician
34153
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
020909149
RAILROAD MEDICARE
MA
05
—
2019701
—
MA
01
—
AX0126
MEDICARE PTAN
—
Enumeration date
11/17/2005
Last updated
05/20/2015
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