Provider Demographics
NPI:1396788212
Name:GRIM, HARLEY A (MD)
Entity type:Individual
Prefix:DR
First Name:HARLEY
Middle Name:A
Last Name:GRIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:8250 WINTON RD
Mailing Address - Street 2:STE 210
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-5916
Mailing Address - Country:US
Mailing Address - Phone:513-931-3400
Mailing Address - Fax:513-728-2672
Practice Address - Street 1:237 WILLIAM HOWARD TAFT RD FL 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2610
Practice Address - Country:US
Practice Address - Phone:513-931-3400
Practice Address - Fax:513-728-2672
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045973173000000X
OH35.045973207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0527111Medicaid
OHA80714Medicare UPIN
OH0537092Medicare PIN