Healthcare Provider Details

I. General information

NPI: 1952372351
Provider Name (Legal Business Name): IAIN L GRANT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 08/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974 BETHEL RD STE A
COLUMBUS OH
43214-2467
US

IV. Provider business mailing address

1810 MACKENZIE DR 2ND FLOOR
COLUMBUS OH
43220-2967
US

V. Phone/Fax

Practice location:
  • Phone: 614-273-1014
  • Fax: 614-273-1015
Mailing address:
  • Phone: 614-273-2234
  • Fax: 614-273-2255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35073998G
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: