Healthcare Provider Details

I. General information

NPI: 1427207133
Provider Name (Legal Business Name): KATE GRANT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2008
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 CULVER RD STE 2A
ROCHESTER NY
14609-1738
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-266-0061
  • Fax:
Mailing address:
  • Phone: 585-922-1304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number254708-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: