Healthcare Provider Details

I. General information

NPI: 1508038217
Provider Name (Legal Business Name): ROBERT R GRONDIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 LINCOLN ST SUITE 202
WORCESTER MA
01605-3646
US

IV. Provider business mailing address

123 SUMMER ST STE 550
WORCESTER MA
01608-1216
US

V. Phone/Fax

Practice location:
  • Phone: 508-757-4003
  • Fax: 508-755-7592
Mailing address:
  • Phone: 508-363-6868
  • Fax: 508-363-6866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2318
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: