Individual
ELY GRACIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0001
(508) 856-6907
Mailing address
55 LAKE AVE N, WORCESTER, MA 01655-0002
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/31/2016
Last updated
05/24/2019
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