Healthcare Provider Details

I. General information

NPI: 1093679409
Provider Name (Legal Business Name): GRT PRACTICE GROUP PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S BEDFORD ST STE 205
BURLINGTON MA
01803-5145
US

IV. Provider business mailing address

111 S BEDFORD ST STE 205
BURLINGTON MA
01803-5145
US

V. Phone/Fax

Practice location:
  • Phone: 800-683-8313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JACOB CROTHERS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 800-683-8313