Organization
EDITH GRANNUM MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDITH GWENDOLINE GRANNUM MD (MEDICAL DIRECTOR)
(585) 233-1366
Entity
Organization
Contact information
Practice address
1815 S CLINTON AVE, ROCHESTER, NY 14618-5720
(585) 233-1366
Mailing address
PO BOX 18545, ROCHESTER, NY 14618-8545
(585) 233-1366
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
210929
NY
Other
Enumeration date
01/31/2008
Last updated
03/19/2008
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