Healthcare Provider Details

I. General information

NPI: 1285077800
Provider Name (Legal Business Name): GWENDOLYN HUNTER GRANT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2013
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 FRANKLIN CORNER RD
LAWRENCEVILLE NJ
08648-2526
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 609-896-1400
  • Fax:
Mailing address:
  • Phone: 856-355-0340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB10114200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: