Healthcare Provider Details

I. General information

NPI: 1538606025
Provider Name (Legal Business Name): ROBERT SEAN GRUETER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2017
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 COLUMBIAN ST
WEYMOUTH MA
02190-1601
US

IV. Provider business mailing address

115 LINCOLN ST
FRAMINGHAM MA
01702-6358
US

V. Phone/Fax

Practice location:
  • Phone: 781-624-5000
  • Fax:
Mailing address:
  • Phone: 508-383-1104
  • Fax: 508-383-1138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA5959
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: