Provider Demographics
NPI:1164489829
Name:GRINMAN, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:GRINMAN
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 1:920 DOUG WHITE DR STE 460
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4182
Mailing Address - Country:US
Mailing Address - Phone:843-449-2336
Mailing Address - Fax:843-692-2174
Practice Address - Street 1:920 DOUG WHITE DR STE 460
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4182
Practice Address - Country:US
Practice Address - Phone:843-449-2336
Practice Address - Fax:843-692-2174
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC204552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC020455800Medicaid
SCG894525879Medicare UPIN
SC020455800Medicaid
SCG89452Medicare UPIN
SCG894525879Medicare UPIN