Provider Demographics
NPI:1942318886
Name:GRADY, CHRISTOPHER SCOTT (MD)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:GRADY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 GORDON GUTMANN BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-282-6114
Mailing Address - Fax:812-282-6340
Practice Address - Street 1:301 GORDON GUTMANN BLVD
Practice Address - Street 2:STE 201
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3764
Practice Address - Country:US
Practice Address - Phone:812-282-6114
Practice Address - Fax:812-282-6340
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054601A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200339400AMedicaid
IN192860CMedicare ID - Type Unspecified
IN200339400AMedicaid