Healthcare Provider Details

I. General information

NPI: 1093392797
Provider Name (Legal Business Name): CHRISTIAN JAMES GRONBECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HERRICK ST
BEVERLY MA
01915-1790
US

IV. Provider business mailing address

PO BOX 24300
NEW YORK NY
10087-4300
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-3000
  • Fax:
Mailing address:
  • Phone: 781-744-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1026512
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: