Healthcare Provider Details

I. General information

NPI: 1932367778
Provider Name (Legal Business Name): NORA YOUSEFZADEH-GRUNIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FRANCIS ST
BOSTON MA
02115-6110
US

IV. Provider business mailing address

75 FRANCIS ST
BOSTON MA
02115-6110
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5500
  • Fax:
Mailing address:
  • Phone: 617-732-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number243651
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number244554-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: