Provider Demographics
NPI:1104083971
Name:GRIMES, MICHAEL P (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:GRIMES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:111 MEDICAL PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0302
Mailing Address - Country:US
Mailing Address - Phone:757-436-2424
Mailing Address - Fax:757-436-7012
Practice Address - Street 1:111 MEDICAL PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0302
Practice Address - Country:US
Practice Address - Phone:757-436-2424
Practice Address - Fax:757-436-7012
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101243328207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics