Provider Demographics
NPI:1437466679
Name:GRASSO, PHILIP EDWARDS (ND)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:EDWARDS
Last Name:GRASSO
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N 14TH ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0697
Mailing Address - Country:US
Mailing Address - Phone:701-751-4464
Mailing Address - Fax:701-751-3947
Practice Address - Street 1:3000 N 14TH ST STE 3A
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0697
Practice Address - Country:US
Practice Address - Phone:701-751-4464
Practice Address - Fax:701-751-3947
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09-1143175F00000X
OR1876175F00000X
ND2024-02175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500645391Medicaid