Healthcare Provider Details

I. General information

NPI: 1548955792
Provider Name (Legal Business Name): MARY GRINSTEAD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE FL 1
PITTSBURGH PA
15224-1334
US

IV. Provider business mailing address

3600 FORBES AVENUE FORBES TOWER PLAZA LEVEL SUITE 1
PITTSBURGH PA
15213
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-5325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4351051221
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: