Healthcare Provider Details

I. General information

NPI: 1467462630
Provider Name (Legal Business Name): JOHN MICHAEL GRANGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 HARRISBURG PIKE SUITE 301
LANCASTER PA
17604
US

IV. Provider business mailing address

2106 HARRISBURG PIKE SUITE 301
LANCASTER PA
17604
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3517
  • Fax: 717-544-3520
Mailing address:
  • Phone: 717-544-3517
  • Fax: 717-544-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD436668
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberC10008084
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: