Active NPI
Ayman Grada, MD
- Dermatology Physician
- Boston, MA
National Provider Identifier
1538613617
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 7002
- Practice address
- 609 Albany St
B600
Boston, MA 02118-2515 - Phone
- (317) 525-5247
- NPI assigned
- Aug 7, 2016
- Reactivated
- May 13, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 7002 | ZZ | Primary |
Addresses
Primary practice location
609 Albany St
B600
Boston, MA 02118-2515
Mailing address
609 Albany St
600B
Boston, MA 02118-2515
Phone (317) 525-5247
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7002 | ZZ | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652400000000",
"number": "1538613617",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "609 ALBANY ST",
"address_2": "600B",
"city": "BOSTON",
"state": "MA",
"postal_code": "021182515",
"telephone_number": "317-525-5247",
"fax_number": "161-763-8551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "609 ALBANY ST",
"address_2": "B600",
"city": "BOSTON",
"state": "MA",
"postal_code": "021182515",
"telephone_number": "317-525-5247"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRADA",
"first_name": "AYMAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-07",
"last_updated": "2022-05-13",
"certification_date": "2022-05-13",
"deactivation_date": "2018-10-09",
"reactivation_date": "2022-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "ZZ",
"license": "7002",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.