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General NPI Number Information
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NPI Number | 1518949346
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Entity Type | Individual
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Provider Name | THOMAS JOSEPH GRADY M.D.,
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Gender | Male
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 20 HOPE AVE STE. 207
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City | WALTHAM
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State | MA
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Zip | 02453-2721
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Country | US
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Telephone | 781-893-6520
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Fax | 781-893-6522
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Provider Business Mailing Address
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Address Line | 20 HOPE AVE STE. 207
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City | WALTHAM
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State | MA
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Zip | 02453-2721
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Country | US
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Telephone | 781-893-6520
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Fax | 781-893-6522
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | A34515
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 34153
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 34153
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License Number State | MA
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