Healthcare Provider Details

I. General information

NPI: 1669427308
Provider Name (Legal Business Name): PAMELA C GROVER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 PENBROOKE DR SUITE #6
PENFIELD NY
14526-2045
US

IV. Provider business mailing address

421 PENBROOKE DR SUITE #6
PENFIELD NY
14526-2045
US

V. Phone/Fax

Practice location:
  • Phone: 585-623-4430
  • Fax: 585-623-4436
Mailing address:
  • Phone: 585-623-4430
  • Fax: 585-623-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME81917
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number271328-1
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number271328
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: