Healthcare Provider Details

I. General information

NPI: 1821090119
Provider Name (Legal Business Name): DAVID MARK GRYGIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 05/08/2017
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 03/29/2006

III. Provider practice location address

24 PARK ST
PITTSFIELD MA
01201-4037
US

IV. Provider business mailing address

24 PARK ST
PITTSFIELD MA
01201-4037
US

V. Phone/Fax

Practice location:
  • Phone: 413-499-6600
  • Fax:
Mailing address:
  • Phone: 413-499-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number79521
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number050835
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: