Healthcare Provider Details

I. General information

NPI: 1407979032
Provider Name (Legal Business Name): STEFAN CHARLES GRANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 TULANE AVE # 8016
NEW ORLEANS LA
70112-2632
US

IV. Provider business mailing address

1430 TULANE AVE # 8016
NEW ORLEANS LA
70112-2632
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-7518
  • Fax: 504-988-8252
Mailing address:
  • Phone: 504-988-7518
  • Fax: 504-988-8252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberEMC0009652
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberEMC0009652
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2014-02170
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number335796
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number30801
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberEMC0009652
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: