MEDICARE: KATE GRANT DO

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	207QS0010X	Sports Medicine (Family Medicine) Physician	254708-1	NY

General Provider Information

NPI Number	:	1427207133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE GRANT DO

Provider Business Mailing Address
First Line	:	100 KINGS HWY S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5504
Country	:	US
Telephone Number	:	585-922-1304
Fax Number	:

Provider Business Practice Location Address
First Line	:	2619 CULVER RD STE 2A
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14609-1738
Country	:	US
Telephone Number	:	585-266-0061
Fax Number	:

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

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	10/18/2022

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