Individual
DR. EDITH GRANNUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1815 CLINTON AVE S STE 330, ROCHESTER, NY 14618-5717
(585) 461-6004
(585) 461-6009
Mailing address
1815 CLINTON AVE S STE 330, ROCHESTER, NY 14618-5717
(585) 461-6000
(585) 461-6009
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
210929
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01894408
—
NY
Enumeration date
02/02/2006
Last updated
06/21/2012
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