MEDICARE: KRISTINE MCGRUDER M.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	207Q00000X	Family Medicine Physician	27871	SC
2	207P00000X	Emergency Medicine Physician	27871	SC

General Provider Information

NPI Number	:	1497955413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE MCGRUDER M.D.

Provider Business Mailing Address
First Line	:	1023 CREEKSIDE MEDICAL DR
Second Line	:
City	:	YORK
State	:	SC
Zip	:	29745-8624
Country	:	US
Telephone Number	:	803-684-3738
Fax Number	:

Provider Business Practice Location Address
First Line	:	2174 CHERRY RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2160
Country	:	US
Telephone Number	:	803-325-8280
Fax Number	:	803-325-8281

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

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	06/09/2016

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