Provider Demographics
NPI:1558461095
Name:GRIMLEY, MARGARET J (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:J
Last Name:GRIMLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 LOHRMAN LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-1612
Mailing Address - Country:US
Mailing Address - Phone:707-331-6872
Mailing Address - Fax:
Practice Address - Street 1:992 LOHRMAN LN
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-1612
Practice Address - Country:US
Practice Address - Phone:707-331-6872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC503352084P0800X, 2084P0804X
ORMD1976192084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0673454Medicaid
OH0710751Medicare UPIN