Provider Demographics
NPI:1952833709
Name:GRIMBERG, DOMINIC CARLTON DEWATERS (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:CARLTON DEWATERS
Last Name:GRIMBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-4500
Mailing Address - Country:US
Mailing Address - Phone:828-253-5314
Mailing Address - Fax:
Practice Address - Street 1:1 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4500
Practice Address - Country:US
Practice Address - Phone:828-253-5314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-01026208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology