Healthcare Provider Details

I. General information

NPI: 1144362740
Provider Name (Legal Business Name): GROTON MEDICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BOSTON RD
GROTON MA
01450-1860
US

IV. Provider business mailing address

100 BOSTON RD
GROTON MA
01450-1860
US

V. Phone/Fax

Practice location:
  • Phone: 978-448-4300
  • Fax: 978-448-4040
Mailing address:
  • Phone: 978-448-4300
  • Fax: 978-448-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS GOODMAN
Title or Position: OWNER PHYSICIAN
Credential: MD
Phone: 978-448-4300