Individual
GRACE MA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2621
(617) 643-2009
Mailing address
PO BOX 13579, READING, PA 19612-3579
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT215275
PA
2085R0202X
Diagnostic Radiology Physician
Primary
290853
MA
Other
Enumeration date
06/05/2018
Last updated
12/13/2024
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