Healthcare Provider Details

I. General information

NPI: 1497495212
Provider Name (Legal Business Name): JEREMY B GRENADIER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 LOTHROP ST STE N715
PITTSBURGH PA
15213-2536
US

IV. Provider business mailing address

3600 FORBES AVE STE 140
PITTSBURGH PA
15213-3410
US

V. Phone/Fax

Practice location:
  • Phone: 412-692-4920
  • Fax:
Mailing address:
  • Phone: 412-692-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD496641
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: