Healthcare Provider Details

I. General information

NPI: 1801956982
Provider Name (Legal Business Name): MARIA KATHERINE MCGRANE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 GARRISON ST SUITE U
LAKEWOOD CO
80215-5898
US

IV. Provider business mailing address

PO BOX 16339
GOLDEN CO
80402-6006
US

V. Phone/Fax

Practice location:
  • Phone: 303-898-2336
  • Fax:
Mailing address:
  • Phone: 303-898-2336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number34220
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: