MEDICARE: DR. GREGORY A. GRINC PH.D.

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	103TC0700X	Clinical Psychologist	1027	DC
2	103TC0700X	Clinical Psychologist	1283	MD

General Provider Information

NPI Number	:	1285682575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY A. GRINC PH.D.

Provider Business Mailing Address
First Line	:	4117 DUNNEL LN
Second Line	:
City	:	KENSINGTON
State	:	MD
Zip	:	20895-3637
Country	:	US
Telephone Number	:	301-933-2565
Fax Number	:	202-478-1717

Provider Business Practice Location Address
First Line	:	1400 20TH ST NW
Second Line	:	SUITE 114
City	:	WASHINGTON
State	:	DC
Zip	:	20036-5906
Country	:	US
Telephone Number	:	202-331-8484
Fax Number	:	202-478-1717

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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