Healthcare Provider Details

I. General information

NPI: 1922530179
Provider Name (Legal Business Name): ROBERT GRANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BROOKLINE AVE # SHAPIRO3
BOSTON MA
02215-5491
US

IV. Provider business mailing address

330 BROOKLINE AVE
BOSTON MA
02215-5491
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-1020
  • Fax: 617-632-1019
Mailing address:
  • Phone: 617-632-1020
  • Fax: 617-632-1019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number1028824
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: