1265495667 NPI number — AARON GRAND MD

Table of content: AARON GRAND MD (NPI 1265495667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265495667 NPI number — AARON GRAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAND
Provider First Name:
AARON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1265495667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6001 STONEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15090-7380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-933-3850
Provider Business Mailing Address Fax Number:
724-933-3860

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6001 STONEWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEXFORD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15090-7380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-933-3850
Provider Business Practice Location Address Fax Number:
724-933-3860
Provider Enumeration Date:
04/08/2006

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: 207XS0106X , with the licence number:  MD424018 , 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: 1540437 . This is a "GATEWAY HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00147891 . This is a "RAILDROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1010963120001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25180380900 . This is a "WV WORKERS COMPENSATION" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1254270001 . This is a "DMERC REGION A" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1616961 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 248052 . This is a "BLUE SHIELD - DME" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 256869 . This is a "HEALTHAMERICA/HEALTHASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7991553 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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