Provider Demographics
NPI:1841223674
Name:GRIMM, SAMUEL OLIVER III (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:OLIVER
Last Name:GRIMM
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:8110 MAPLE LAWN BLVD STE 235
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MD
Mailing Address - Zip Code:20759-2694
Mailing Address - Country:US
Mailing Address - Phone:301-340-8339
Mailing Address - Fax:301-340-9027
Practice Address - Street 1:10521 ROSEHAVEN ST
Practice Address - Street 2:SUITE LL 100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2837
Practice Address - Country:US
Practice Address - Phone:703-281-5000
Practice Address - Fax:703-255-0765
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-05-13
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Provider Licenses
StateLicense IDTaxonomies
VA0101043338207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV006215653Medicaid
VAE30501Medicare UPIN