MEDICARE: DR. JOHN GRANDRIMO D.O.

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	207X00000X	Orthopaedic Surgery Physician	OS012323	PA

General Provider Information

NPI Number	:	1093719031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN GRANDRIMO D.O.

Provider Business Mailing Address
First Line	:	3399 TRINDLE RD
Second Line	:
City	:	CAMP HILL
State	:	PA
Zip	:	17011-4407
Country	:	US
Telephone Number	:	717-761-5530
Fax Number	:	717-737-7197

Provider Business Practice Location Address
First Line	:	820 SIR THOMAS CT
Second Line	:
City	:	HARRISBURG
State	:	PA
Zip	:	17109-4839
Country	:	US
Telephone Number	:	717-652-9555
Fax Number	:	717-652-9297

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	10/31/2019

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