Healthcare Provider Details

I. General information

NPI: 1790711430
Provider Name (Legal Business Name): RAFAEL J GROSSMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 09/26/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BORTHWICK AVE SUITE 308
PORTSMOUTH NH
03801
US

IV. Provider business mailing address

43 WHITING HILL RD STE 300
BREWER ME
04412-1006
US

V. Phone/Fax

Practice location:
  • Phone: 603-334-6260
  • Fax: 603-334-6253
Mailing address:
  • Phone: 207-973-5035
  • Fax: 207-973-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number016406
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: