Healthcare Provider Details

I. General information

NPI: 1730538604
Provider Name (Legal Business Name): GRANT PIERRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 HARVARD ST STE 104
WORCESTER MA
01609-2828
US

IV. Provider business mailing address

3 WALTER ST
WORCESTER MA
01609-1031
US

V. Phone/Fax

Practice location:
  • Phone: 774-275-3367
  • Fax: 508-519-0577
Mailing address:
  • Phone: 774-275-3367
  • Fax: 508-519-0577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number283910
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10057233
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number283910
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: