Individual
DR. MARC JAMES GRELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT ST, PEDIATRIC GROUP PRACTICE YAW 6D, BOSTON, MA 02114-2621
(617) 726-2728
(617) 724-3948
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 726-2728
(617) 724-3948
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
151202
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151202
TUFTS HEALTH PLAN
MA
05
—
3155617
—
MA
01
—
J16850
BCBS MA
MA
Enumeration date
10/28/2005
Last updated
09/07/2012
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