Provider Demographics
NPI:1538613617
Name:GRADA, AYMAN (MD)
Entity type:Individual
Prefix:
First Name:AYMAN
Middle Name:
Last Name:GRADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 ALBANY ST
Mailing Address - Street 2:600B
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2515
Mailing Address - Country:US
Mailing Address - Phone:317-525-5247
Mailing Address - Fax:161-763-8551
Practice Address - Street 1:609 ALBANY ST
Practice Address - Street 2:B600
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2515
Practice Address - Country:US
Practice Address - Phone:317-525-5247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-07
Last Update Date:2022-05-13
Deactivation Date:2018-10-09
Deactivation Code:
Reactivation Date:2022-05-13
Provider Licenses
StateLicense IDTaxonomies
ZZ7002207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology