Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 239455 | MA |
Y | 207QA0401X | Family Doctor - Addiction Medicine | 239455 | MA |
NPI | 1528114857 |
---|---|
Provider Name | Dr. Janet Mary Grimes |
First Address | Springfield, MA 01104-3736 |
Second Address | Springfield, MA 01104-3736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2007 |
Last Update Date | 25/02/2020 |