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General NPI Number Information
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NPI Number | 1295110971
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Entity Type | Organization
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Legal Business Name | BENJAMIN GRAJALES MDPC
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Dates
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Enumeration Date | 07/23/2015
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 50 MEMORIAL DR STE 204
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City | LEOMINSTER
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State | MA
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Zip | 01453-2238
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Country | US
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Telephone | 978-534-1534
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Fax | 978-534-3710
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Provider Business Mailing Address
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Address Line | 50 MEMORIAL DR STE 204
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City | LEOMINSTER
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State | MA
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Zip | 01453-2238
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Country | US
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Telephone | 978-534-1534
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Fax | 978-534-3710
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BENJAMIN GRAJALES
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Credential | MD
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Telephone | 978-534-1534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 70381
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License Number State | MA
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