Healthcare Provider Details

I. General information

NPI: 1366550014
Provider Name (Legal Business Name): OSCAR H. GRANDAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 ALCOA HWY STE E 120
KNOXVILLE TN
37920
US

IV. Provider business mailing address

PO BOX 440265
NASHVILLE TN
37244-0265
US

V. Phone/Fax

Practice location:
  • Phone: 865-305-8040
  • Fax: 865-305-8041
Mailing address:
  • Phone: 865-670-6199
  • Fax: 865-670-6198

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number38851
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number38851
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: