MEDICARE: DR. NICHOLAS ANTHONY GRIMALDI 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	D01840	TN
2	207X00000X	Orthopaedic Surgery Physician	DO87813	SC
3	207XS0117X	Orthopaedic Surgery of the Spine Physician	DO 1840	TN
4	207XS0117X	Orthopaedic Surgery of the Spine Physician	DO87813	SC
5	207X00000X	Orthopaedic Surgery Physician	DO1840	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1729701	OTHER	TN	CIGNA HEALTHCARE
2	4299333	OTHER	TN	BCBS OF TENNESSEE

General Provider Information

NPI Number	:	1528080777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS ANTHONY GRIMALDI D.O.

Provider Business Mailing Address
First Line	:	509 OLD COMPASS RD
Second Line	:
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-8604
Country	:	US
Telephone Number	:	717-586-9936
Fax Number	:

Provider Business Practice Location Address
First Line	:	114 GATEWAY CORPORATE BLVD STE 240
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29203-9785
Country	:	US
Telephone Number	:	803-365-8660
Fax Number	:

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	04/29/2025

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Directions to “ DR. NICHOLAS ANTHONY GRIMALDI D.O.” Practice Location

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