Healthcare Provider Details

I. General information

NPI: 1407887185
Provider Name (Legal Business Name): CAROLYN HEYWARD GROSVENOR MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE STRATTON VA MEDICAL CENTER MVAC-PRIMARY CARE
ALBANY NY
12208-3410
US

IV. Provider business mailing address

113 HOLLAND AVE STRATTON VA MEDICAL CENTER MVAC-PRIMARY CARE
ALBANY NY
12208-3410
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-6560
  • Fax: 518-626-6563
Mailing address:
  • Phone: 518-626-6560
  • Fax: 518-626-6563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number146531
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: