1467462630 NPI number — DR. JOHN MICHAEL GRANGER M.D.

Table of content: DR. JOHN MICHAEL GRANGER M.D. (NPI 1467462630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467462630 NPI number — DR. JOHN MICHAEL GRANGER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANGER
Provider First Name:
JOHN
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467462630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2106 HARRISBURG PIKE
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-544-3517
Provider Business Mailing Address Fax Number:
717-544-3520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2106 HARRISBURG PIKE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-544-3517
Provider Business Practice Location Address Fax Number:
717-544-3520
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  C10008084 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: MD436668 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 082109 . This is a "MEDICARE PTAN/GROUP ID NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00340818 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 102039150 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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