Individual
NEIL J GROSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 MASSACHUSETTS AVE., CROSSTOWN BLDG FL 7, BOSTON, MA 02118
(617) 414-4841
Mailing address
BMC PROVIDER ENROLLMENT OFFICE, 960 MASSACHUSETTS AVE,.2ND FLOOR, BOSTON, MA 02118
(617) 414-5405
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
238502
MA
2080P0207X
Pediatric Hematology & Oncology Physician
Primary
238502
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110081553A
—
MA
Enumeration date
06/16/2006
Last updated
04/04/2024
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