Healthcare Provider Details

I. General information

NPI: 1083683130
Provider Name (Legal Business Name): GRAHAM L SPRUIELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VALLEY REGIONAL MEDICAL SERVICES 70 EAST STREET
METHUEN MA
01844
US

IV. Provider business mailing address

VALLEY REGIONAL MEDICAL SERVICES P.O. BOX 414060
BOSTON MA
02241-0001
US

V. Phone/Fax

Practice location:
  • Phone: 978-688-0773
  • Fax: 978-681-6173
Mailing address:
  • Phone: 617-562-5460
  • Fax: 617-562-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number52192
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: