Provider Demographics
NPI:1538101407
Name:GRIMM, DAVID CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:GRIMM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:229 PARRISH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1791
Mailing Address - Country:US
Mailing Address - Phone:585-394-1960
Mailing Address - Fax:585-393-9232
Practice Address - Street 1:229 PARRISH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1791
Practice Address - Country:US
Practice Address - Phone:585-394-1960
Practice Address - Fax:585-393-9232
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY196161207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7073233OtherAETNA
NY101522CUOtherPREFERRED CARE
NY01827467Medicaid
NY918780001OtherHEALTHNOW
NY010196161OtherEXCELLUS ROCHESTER
NY0599066OtherGHI
CC7410Medicare ID - Type Unspecified
G76498Medicare UPIN