Basic Information
| Provider Information | |||||||||
| NPI: | 1801865662 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GROTZ | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1350 BELMONT ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023014430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7747762991 | ||||||||
| FaxNumber: | 7747762996 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PEARL ST | ||||||||
| Address2: | SUITE 2700 | ||||||||
| City: | BROCKTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023012864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085844104 | ||||||||
| FaxNumber: | 5085844105 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 08/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 77137 | MA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | P00092280 | 01 | MA | RR MEDICARE | OTHER | 14-00003 | 01 | MA | UNITED HEALTHCARE | OTHER | 300852540 | 01 | MA | HEALTHNET | OTHER | 0013819 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | 29256 | 01 | MA | HARVARD PILGRIM | OTHER | 3109950 | 05 | MA | MEDICAID | 77137 | 01 | MA | TUFTS PROV# | OTHER | GRJ13652 | 01 | MA | BLUE CROSS BLUE SHIELD | OTHER | 454450 | 01 | MA | AETNA HEALTHCARE | OTHER |