Healthcare Provider Details

I. General information

NPI: 1386873271
Provider Name (Legal Business Name): ANNA V. AGRANOVICH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE 600 N. WOLFE STREET
BALTIMORE MD
21287-0001
US

IV. Provider business mailing address

JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE 600 N. WOLFE STREET
BALTIMORE MD
21287-0001
US

V. Phone/Fax

Practice location:
  • Phone: 919-360-5656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04811
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number04811
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: