Healthcare Provider Details

I. General information

NPI: 1790781003
Provider Name (Legal Business Name): CATHERINE E GRANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GARTON PLZ
WESTON WV
26452-2128
US

IV. Provider business mailing address

25 GARTON PLZ
WESTON WV
26452-2128
US

V. Phone/Fax

Practice location:
  • Phone: 304-269-6620
  • Fax: 304-269-4593
Mailing address:
  • Phone: 304-269-6620
  • Fax: 304-269-4593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15127
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: