1508866229 NPI number — DR. DAVID SAMUEL GRANITE M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508866229 NPI number — DR. DAVID SAMUEL GRANITE M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GRANITE

Provider First Name:

DAVID

Provider Middle Name:

SAMUEL

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1508866229

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/24/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

7500 HANOVER PKWY STE 206

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

GREENBELT

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

20770-2009

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

301-474-2141

Provider Business Mailing Address Fax Number:

301-345-3874

Provider First Line Business Practice Location Address:

7500 HANOVER PKWY STE 206

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

GREENBELT

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

20770-2009

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

301-474-2141

Provider Business Practice Location Address Fax Number:

301-345-3874

Provider Enumeration Date:

07/22/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  D0017572 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 60370006 . This is a "BCBS OF NATL CAP" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 1031290 . This is a "AFFORDABLE/1ST HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 4051960 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 41447001 . This is a "BCBS OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 522040780 . This is a "PHCS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 7975077 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 246432 . This is a "MAMSI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 522040780 . This is a "ONE HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 080137996 . This is a "MEDICARE RR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 735966 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 18061012 . This is a "UNITED HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
• Identifier: 302151300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".