Provider Demographics
NPI:1225285125
Name:GRIMM, SHAWNA M (DO)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:M
Last Name:GRIMM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1615
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-1615
Mailing Address - Country:US
Mailing Address - Phone:304-285-3679
Mailing Address - Fax:304-285-3694
Practice Address - Street 1:1600 MEDICAL CENTER DR STE 2500
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3657
Practice Address - Country:US
Practice Address - Phone:304-691-1200
Practice Address - Fax:304-691-1287
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV2891208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery