Healthcare Provider Details

I. General information

NPI: 1780174086
Provider Name (Legal Business Name): JONATHAN E. GERBODE-GRANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2018
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 BOYLSTON ST STE 205
CHESTNUT HILL MA
02467-2502
US

IV. Provider business mailing address

830 BOYLSTON ST STE 205
CHESTNUT HILL MA
02467-2502
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-1318
  • Fax: 617-734-5763
Mailing address:
  • Phone: 617-732-1318
  • Fax: 617-734-5763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2312745
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: