Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 24921 | WV |
NPI | 1457517658 |
---|---|
Provider Name | Dr. Oulimata Kane Grossman |
First Address | Morgantown, WV 26505 |
Second Address | Morgantown, WV 26505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2008 |
Last Update Date | 03/08/2012 |