Healthcare Provider Details

I. General information

NPI: 1699170803
Provider Name (Legal Business Name): ANNE GRAND'MAISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ELM AND CARLTON STREETS
BUFFALO NY
14263-0001
US

IV. Provider business mailing address

1515 HOLCOMBE BLVD # FC123055
HOUSTON TX
77030-4000
US

V. Phone/Fax

Practice location:
  • Phone: 716-845-2300
  • Fax:
Mailing address:
  • Phone: 713-745-5351
  • Fax: 713-563-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code284300000X
TaxonomySpecial Hospital
License NumberBP10050716
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number286655
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: