Healthcare Provider Details

I. General information

NPI: 1831315589
Provider Name (Legal Business Name): KELLY GROVE NIGRO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY GROVE MD

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8166 MARKET ST
YOUNGSTOWN OH
44512-6262
US

IV. Provider business mailing address

8166 MARKET ST SUITE D
YOUNGSTOWN OH
44512-6262
US

V. Phone/Fax

Practice location:
  • Phone: 330-953-3242
  • Fax:
Mailing address:
  • Phone: 330-953-3242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number086015
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: