Provider Demographics
NPI:1689676876
Name:GRADY, ANN E (MD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:E
Last Name:GRADY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1565 N MAIN ST
Mailing Address - Street 2:STE 306
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2972
Mailing Address - Country:US
Mailing Address - Phone:508-679-5911
Mailing Address - Fax:508-324-7605
Practice Address - Street 1:1565 N MAIN ST
Practice Address - Street 2:STE 306
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2972
Practice Address - Country:US
Practice Address - Phone:508-679-5911
Practice Address - Fax:508-324-7605
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA42781207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3145212Medicaid
MAJ14268Medicare PIN
MA3145212Medicaid