Basic Information
| Provider Information | |||||||||
| NPI: | 1972664522 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRASSO | ||||||||
| FirstName: | MARIO | ||||||||
| MiddleName: | LUCIO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31 WARD PL | ||||||||
| Address2: | |||||||||
| City: | SOUTH ORANGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070792529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738561934 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3400 SPRUCE ST | ||||||||
| Address2: | 1 MALONEY BUILDING | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191044206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156623793 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 05/21/2009 | ||||||||
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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 | 207L00000X | MT186316 | PA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 25MA08550900 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 251884-1 | NY | N | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.