=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629045646
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHEN D GROSKIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2006
-----------------------------------------------------
Last Update Date | 06/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 546 MAIN ROAD PRIMA CARE, PC
-----------------------------------------------------
City | TIVERTON
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02878-1350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-816-5110
-----------------------------------------------------
Fax | 401-816-5480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1070 PRIMA CARE, PC
-----------------------------------------------------
City | FALL RIVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02722-1070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-676-3292
-----------------------------------------------------
Fax | 508-672-7181
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD12295
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------