Provider Demographics
NPI:1720039340
Name:GRINO, AGRIPINA D (MD)
Entity Type:Individual
Prefix:
First Name:AGRIPINA
Middle Name:D
Last Name:GRINO
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 1:609 JAMES TRIMBLE BLVD
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1055
Mailing Address - Country:US
Mailing Address - Phone:606-789-6844
Mailing Address - Fax:606-789-4157
Practice Address - Street 1:609 JAMES TRIMBLE BLVD
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1055
Practice Address - Country:US
Practice Address - Phone:606-789-6844
Practice Address - Fax:606-789-4157
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19716207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64197163Medicaid
KY64197163Medicaid
KY00054003Medicare PIN