Healthcare Provider Details

I. General information

NPI: 1104284686
Provider Name (Legal Business Name): NARINA GROVE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NARINE KHECHUMOVA

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 WRIGHT DR
LOVELAND CO
80538-8806
US

IV. Provider business mailing address

5802 WRIGHT DR
LOVELAND CO
80538-8806
US

V. Phone/Fax

Practice location:
  • Phone: 970-212-0530
  • Fax:
Mailing address:
  • Phone: 970-212-0530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberDR.0062597
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA139811
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: