MEDICARE: DR. ANITA M GRASSI 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	207N00000X	Dermatology Physician	71817	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	715913	OTHER	MA	TUFTS HEALTH PLAN
2	J09537	OTHER	MA	BCBS MA

General Provider Information

NPI Number	:	1831189513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANITA M GRASSI MD

Provider Business Mailing Address
First Line	:	PO BOX 9142
Second Line	:
City	:	CHARLESTOWN
State	:	MA
Zip	:	02129-9142
Country	:	US
Telephone Number	:	617-724-6960
Fax Number	:	617-724-6970

Provider Business Practice Location Address
First Line	:	50 STANIFORD ST
Second Line	:	SUITE 250
City	:	BOSTON
State	:	MA
Zip	:	02114-2517
Country	:	US
Telephone Number	:	617-724-6960
Fax Number	:	617-724-6970

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	09/07/2012

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