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NPI Code Detail

MEDICARE: DR. MICHAEL J GRASSO MD

MEDICARE: DR. MICHAEL J GRASSO 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
1207R00000XInternal Medicine PhysicianMD421560PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558374983
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL J GRASSO MD
Provider Business Mailing Address
First Line : 610 WYOMING AVE
Second Line :
City : KINGSTON
State : PA
Zip : 18704-3702
Country : US
Telephone Number : 570-288-5441
Fax Number : 570-288-5842
Provider Business Practice Location Address
First Line : 500 SCOTT ST
Second Line :
City : WILKES BARRE
State : PA
Zip : 18702-5616
Country : US
Telephone Number : 570-824-1700
Fax Number : 570-824-1300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 12/17/2021

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