Provider Demographics
NPI:1144313198
Name:GRIMBERG, IRINA IVANOVNA (MD)
Entity type:Individual
Prefix:DR
First Name:IRINA
Middle Name:IVANOVNA
Last Name:GRIMBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2925 DEBARR ROAD
Mailing Address - Street 2:BUILDING D, SUITE 215
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-764-3292
Mailing Address - Fax:
Practice Address - Street 1:2925 DEBARR ROAD
Practice Address - Street 2:BUILDING D, SUITE 215
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-764-3292
Practice Address - Fax:907-272-6751
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5449207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK5449OtherSTATE MEDICAL LICENSE
AKMD5525Medicaid
AKMD5525Medicaid
AKI16130Medicare UPIN
AK5449OtherSTATE MEDICAL LICENSE