Provider Demographics
NPI:1952504169
Name:GRIGORYEVA, ANNA (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GRIGORYEVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:GRIGORYEVE-POLOUNIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:22 ST PAUL DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1036
Practice Address - Country:US
Practice Address - Phone:717-217-6870
Practice Address - Fax:717-217-6945
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435059207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00741669OtherRAILROAD MEDICARE
PA25-1716306OtherINTERGROUP
PA25-1716306OtherHEALTH AMERICA
PA102323756 0001Medicaid
PA50086443OtherCAPITAL BLUECROSS
PAMD435059OtherLICENSE
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PAGR2105179OtherHIGHMARK BLUE SHIELD
PA25-1716306OtherGREATWEST
PA25-1716306OtherFIRST HEALTH
PA25-1716306OtherDEVON
PAG920-0120/KDM4CUOtherCAREFIRST
PA2212067OtherMAMSI
PA25-1716306OtherINFORMED
PA25-1716306OtherMULTIPLAN/PHCS
PA276094OtherUNISON
PA867633OtherMEDICARE GROUP #
PA9214076OtherAETNA NON-HMO
PA120420405OtherDEPT OF LABOR
PA25-1716306OtherHEALTHNET/TRICARE
PA6955538OtherAETNA HMO
PA6955538OtherAETNA HMO
PA25-1716306OtherINTERGROUP
PA9214076OtherAETNA NON-HMO
DCG02697Medicare PIN