Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 48781 | MA |
N | 111NI0900X | Internist | 48781 | MA |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 48781 | MA |
NPI | 1073589628 |
---|---|
Provider Name | Dr. Antonio Granfone |
First Address | Charlestown, MA 02129-9142 |
Second Address | Revere, MA 02151-5035 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2006 |
Last Update Date | 29/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3010261 | (05) | MA |
716085 | TUFTS HEALTH PLAN (01) | MA |
D88414 | (02) | |
J05333 | BCBS MA (01) | MA |