Provider Demographics
NPI:1699743419
Name:GRIMM, CORDELIA T (MD)
Entity type:Individual
Prefix:DR
First Name:CORDELIA
Middle Name:T
Last Name:GRIMM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CORDELIA
Other - Middle Name:T
Other - Last Name:GRIMM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:601 SOUTH CHARLES STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230
Mailing Address - Country:US
Mailing Address - Phone:410-547-8500
Mailing Address - Fax:
Practice Address - Street 1:611 SOUTH CHARLES STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230
Practice Address - Country:US
Practice Address - Phone:410-547-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H10224Medicare UPIN