Healthcare Provider Details

I. General information

NPI: 1154600534
Provider Name (Legal Business Name): GRANT RICHARD BRAME MSPAS, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2011
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 PLEASANTVILLE RD SUITE 202
LANCASTER OH
43130-3312
US

IV. Provider business mailing address

1153 E MAIN ST PO BOX 2563
LANCASTER OH
43130-4056
US

V. Phone/Fax

Practice location:
  • Phone: 740-681-9020
  • Fax: 740-681-9112
Mailing address:
  • Phone: 740-687-8990
  • Fax: 740-687-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number50.003315RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: