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General NPI Number Information
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NPI Number | 1447282116
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Entity Type | Individual
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Provider Name | TRACEY P GRIM MD
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 100 WELLNESS WAY
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City | MILFORD
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State | DE
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Zip | 19963-4364
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Country | US
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Telephone | 302-422-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 777 LOWNDES HILL RD BLDG 1
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City | GREENVILLE
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State | SC
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Zip | 29607-2101
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Country | US
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Telephone | 800-967-2289
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Fax | 855-621-7065
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD044957E
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License Number State | PA
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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 | C1-0011097
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License Number State | DE
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