# EDITH GRANNUM MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104003235
- **Authorized official:** DR. EDITH GWENDOLINE GRANNUM MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (585) 233-1366

## Contact information

- **Practice address:** 1815 S CLINTON AVE, ROCHESTER, NY 14618-5720
- **Practice address phone:** (585) 233-1366
- **Mailing address:** PO BOX 18545, ROCHESTER, NY 14618-8545
- **Mailing address phone:** (585) 233-1366

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 210929 | NY | Yes |

## Other

- **Enumeration date:** 01/31/2008
- **Last updated:** 03/19/2008