MEDICARE: KRISTIN A GRIMES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD12296	RI
2	2080A0000X	Pediatric Adolescent Medicine Physician	MD12296	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD12296	OTHER	RI	MEDICAL LICENSE

General Provider Information

NPI Number	:	1063618783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN A GRIMES MD

Provider Business Mailing Address
First Line	:	175 NATE WHIPPLE HWY STE 102
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-1422
Country	:	US
Telephone Number	:	401-334-5437
Fax Number	:	401-334-3571

Provider Business Practice Location Address
First Line	:	175 NATE WHIPPLE HWY STE 102
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-1422
Country	:	US
Telephone Number	:	401-334-5437
Fax Number	:	401-334-3571

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	03/07/2023

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Directions to “ KRISTIN A GRIMES MD” Practice Location

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