Healthcare Provider Details

I. General information

NPI: 1407046501
Provider Name (Legal Business Name): KATHERINE E GRIMES M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WALL STREET HVMA ATRIUS HEALTH
BURLINGTON MA
01803-4758
US

IV. Provider business mailing address

120 BEACON ST FL 4
SOMERVILLE MA
02143-4370
US

V. Phone/Fax

Practice location:
  • Phone: 781-221-2500
  • Fax:
Mailing address:
  • Phone: 617-503-8454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number47494
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: