Provider Demographics
NPI:1295917409
Name:KAREN R GRASSIE MD INC
Entity type:Organization
Organization Name:KAREN R GRASSIE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-352-0646
Mailing Address - Street 1:50 NORMANDY DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-1600
Mailing Address - Country:US
Mailing Address - Phone:440-352-0646
Mailing Address - Fax:440-352-0648
Practice Address - Street 1:50 NORMANDY DR
Practice Address - Street 2:SUITE 4
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1600
Practice Address - Country:US
Practice Address - Phone:440-352-0646
Practice Address - Fax:440-352-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2327771Medicaid
OHH68264Medicare UPIN
OH2327771Medicaid