Basic Information
| Provider Information | |||||||||
| NPI: | 1942318886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRADY | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 GORDON GUTMANN BLVD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122826114 | ||||||||
| FaxNumber: | 8122826340 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 GORDON GUTMANN BLVD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471303764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122826114 | ||||||||
| FaxNumber: | 8122826340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2006 | ||||||||
| LastUpdateDate: | 06/29/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 01054601A | IN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 200339400A | 05 | IN | MEDICAID |