Provider Demographics
NPI:1750341640
Name:GRADY, KATHERINE M (CMF)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:M
Last Name:GRADY
Suffix:
Gender:F
Credentials:CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 APPIAN DR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-8404
Mailing Address - Country:US
Mailing Address - Phone:585-872-6731
Mailing Address - Fax:585-223-0613
Practice Address - Street 1:240 PACKETTS LNDG
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1569
Practice Address - Country:US
Practice Address - Phone:585-223-0610
Practice Address - Fax:585-223-0613
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCC16385174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0813730001Medicare ID - Type UnspecifiedGROUP