Individual
ANDREW GRISCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 BREWSTER ST, DEPARTMENT OF EMERGENCY MEDICINE, PAWTUCKET, RI 02860-4400
(401) 729-2191
(401) 729-2517
Mailing address
111 BREWSTER ST, DEPARTMENT OF EMERGENCY MEDICINE, PAWTUCKET, RI 02860-4400
(401) 729-2191
(401) 729-2517
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34668
CT
207P00000X
Emergency Medicine Physician
MD09664
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007061007
MEDICARE PTAN
RI
05
—
7006158
—
RI
Enumeration date
11/25/2005
Last updated
05/15/2023
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