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General NPI Number Information
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NPI Number | 1841223674
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Entity Type | Individual
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Provider Name | SAMUEL OLIVER GRIMM III M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 10521 ROSEHAVEN ST SUITE LL 100
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City | FAIRFAX
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State | VA
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Zip | 22030-2837
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Country | US
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Telephone | 703-281-5000
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Fax | 703-255-0765
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Provider Business Mailing Address
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Address Line | 8110 MAPLE LAWN BLVD STE 235
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City | FULTON
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State | MD
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Zip | 20759-2694
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Country | US
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Telephone | 301-340-8339
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Fax | 301-340-9027
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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 | 0101043338
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License Number State | VA
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