MEDICARE: DR. RICHARD SAUL GROSSMAN M.D.

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	013580	ME

Other Identifiers

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

General Provider Information

NPI Number	:	1962508655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD SAUL GROSSMAN M.D.

Provider Business Mailing Address
First Line	:	10 OLE MUSKET RD
Second Line	:	UNIT 5
City	:	CUMBERLAND FORESIDE
State	:	ME
Zip	:	04110-1422
Country	:	US
Telephone Number	:	207-400-0142
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 OLE MUSKET RD
Second Line	:	UNIT 5
City	:	CUMBERLAND FORESIDE
State	:	ME
Zip	:	04110-1422
Country	:	US
Telephone Number	:	207-400-0142
Fax Number	:

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	12/15/2010

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