Provider Demographics
NPI:1922061845
Name:DIMITROFF, GRACE D (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:D
Last Name:DIMITROFF
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:8205 MAIN STREET
Mailing Address - Street 2:STE. 10
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6054
Mailing Address - Country:US
Mailing Address - Phone:716-539-0789
Mailing Address - Fax:716-250-9090
Practice Address - Street 1:2924 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1720
Practice Address - Country:US
Practice Address - Phone:718-837-0995
Practice Address - Fax:716-837-1203
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY192531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01435785Medicaid