Provider Demographics
NPI:1700069895
Name:GRIGORIEVA, ANASTASSIA (MD)
Entity Type:Individual
Prefix:
First Name:ANASTASSIA
Middle Name:
Last Name:GRIGORIEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 THOMAS MORE PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5101
Mailing Address - Country:US
Mailing Address - Phone:859-301-2211
Mailing Address - Fax:859-301-2511
Practice Address - Street 1:340 THOMAS MORE PKWY STE 220
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5101
Practice Address - Country:US
Practice Address - Phone:859-301-2211
Practice Address - Fax:859-301-2511
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.134847207L00000X
KY52099207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD554415700Medicaid
MD219747YUWMedicare PIN