MEDICARE: ANGELA GRIMALDI PA

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	363A00000X	Physician Assistant	085003337	IL
2	363A00000X	Physician Assistant	113	VI

General Provider Information

NPI Number	:	1295987345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA GRIMALDI PA

Provider Business Mailing Address
First Line	:	4001 RAPHUNE HILL RD
Second Line	:
City	:	ST THOMAS
State	:	VI
Zip	:	00802-2905
Country	:	US
Telephone Number	:	340-774-2331
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 RAPHUNE HILL RD
Second Line	:
City	:	ST THOMAS
State	:	VI
Zip	:	00802-2905
Country	:	US
Telephone Number	:	340-774-2331
Fax Number	:

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	11/25/2024

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