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General NPI Number Information
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NPI Number | 1346653334
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Entity Type | Individual
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Provider Name | ANNA WEAVER GRADY MD
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Gender | Female
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 213 MIDDLEBURY ST
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City | GOSHEN
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State | IN
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Zip | 46528-2956
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Country | US
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Telephone | 574-534-3300
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Fax | 574-534-5412
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Provider Business Mailing Address
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Address Line | 213 MIDDLEBURY ST
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City | GOSHEN
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State | IN
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Zip | 46528-2956
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Country | US
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Telephone | 574-534-3300
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Fax | 574-534-5412
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036142675
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01076657A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01076657A
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License Number State | IN
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