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NPI Code Detail

MEDICARE: DIANE E GRASSO NP

MEDICARE: DIANE E GRASSO NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician191199MA
2363LF0000XFamily Nurse Practitioner191199MA

General Provider Information

NPI Number : 1417965765
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE E GRASSO NP
Provider Business Mailing Address
First Line : 201 S MAIN ST STE 1
Second Line :
City : ATHOL
State : MA
Zip : 01331-2117
Country : US
Telephone Number : 978-249-0099
Fax Number : 978-249-7227
Provider Business Practice Location Address
First Line : 201 S MAIN ST STE 1
Second Line :
City : ATHOL
State : MA
Zip : 01331-2117
Country : US
Telephone Number : 978-249-0099
Fax Number : 978-249-7227
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2006
Last Update Date : 05/24/2016

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Directions to “ DIANE E GRASSO NP” Practice Location

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