Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | DS018609L | PA |
Y | 213EG0000X | General Practice | DS018609L | PA |
NPI | 1003820242 |
---|---|
Provider Name | Dr. Richard A Grimaldi |
First Address | Connellsville, PA 15425-2643 |
Second Address | Connellsville, PA 15425-2643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |