Provider Demographics
NPI:1538150982
Name:GREVELINK, JOANNES M (MD PHD)
Entity type:Individual
Prefix:DR
First Name:JOANNES
Middle Name:M
Last Name:GREVELINK
Suffix:
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:30 LANCASTER STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114
Mailing Address - Country:US
Mailing Address - Phone:617-722-4100
Mailing Address - Fax:617-227-1134
Practice Address - Street 1:30 LANCASTER STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-722-4100
Practice Address - Fax:617-227-1134
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2019-05-13
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Provider Licenses
StateLicense IDTaxonomies
MA60705207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3057623Medicaid
MA060705OtherTUFTS HEALTH PLAN
MAJ08910OtherBCBS MA
E16372Medicare UPIN
MA3057623Medicaid