| Edith Grannum Md Pc | |
|
1815 S Clinton Ave Rochester NY 14618-5720 | |
| (585) 233-1366 | |
| Not Available |
| Full Name | Edith Grannum Md Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 1815 S Clinton Ave, Rochester, New York |
| Authorized Official Name and Position | Edith Gwendoline Grannum (MEDICAL DIRECTOR) |
| Authorized Official Contact | 5852331366 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edith Grannum Md Pc Po Box 18545 Rochester NY 14618-8545 Ph: (585) 233-1366 | Edith Grannum Md Pc 1815 S Clinton Ave Rochester NY 14618-5720 Ph: (585) 233-1366 |
| NPI Number | 1104003235 |
|---|---|
| Provider Enumeration Date | 01/31/2008 |
| Last Update Date | 03/19/2008 |
| Medicare PECOS PAC ID | 6103995105 |
|---|---|
| Medicare Enrollment ID | O20080529000571 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104003235 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 210929 (New York) | Primary |
| Provider Name | Edith G Grannum |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821060237 PECOS PAC ID: 2466351143 Enrollment ID: I20031231000579 |
| Provider Name | Mary M Wadsworth |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801868997 PECOS PAC ID: 1355317397 Enrollment ID: I20040909001142 |
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