MEDICARE: DR. PETER A. GRAPE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	46505	MA
2	207RC0000X	Cardiovascular Disease Physician	46505	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	703699	OTHER	MA	TUFTS HEALTH PLAN
2	0036418	OTHER	MA	NEIGHBORHOOD HEALTH PLAN
3	49093	OTHER	MA	FALLON COMMUNITY HEALTH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	J01041	OTHER	MA	BLUE CROSS BLUE SHIELD
6	3046	OTHER	MA	HARVARD PILGRIM

General Provider Information

NPI Number	:	1346249000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER A. GRAPE MD

Provider Business Mailing Address
First Line	:	541 MAIN ST
Second Line	:	SUITE 400
City	:	SOUTH WEYMOUTH
State	:	MA
Zip	:	02190-1868
Country	:	US
Telephone Number	:	781-952-1200
Fax Number	:	781-340-1610

Provider Business Practice Location Address
First Line	:	541 MAIN ST
Second Line	:	SUITE 400
City	:	SOUTH WEYMOUTH
State	:	MA
Zip	:	02190-1868
Country	:	US
Telephone Number	:	781-952-1200
Fax Number	:	781-340-1610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	01/15/2015

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