Provider Demographics
NPI:1407892086
Name:GRENADIR, IRA N (DPM)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:N
Last Name:GRENADIR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 WALDEN STREET
Mailing Address - Street 2:STE. 5J
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-3511
Mailing Address - Country:US
Mailing Address - Phone:617-492-1827
Mailing Address - Fax:
Practice Address - Street 1:205 WALDEN STREET
Practice Address - Street 2:STE.APT. 5J
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-3511
Practice Address - Country:US
Practice Address - Phone:617-492-1827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1556213E00000X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Not Answered213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine