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General NPI Number Information
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NPI Number | 1013125350
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Entity Type | Individual
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Provider Name | RONALD ALFRED GRANT M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 45 E PUTNAM AVE
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City | GREENWICH
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State | CT
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Zip | 06830-5438
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Country | US
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Telephone | 203-629-3880
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Fax | 203-262-6593
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Provider Business Mailing Address
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Address Line | PO BOX 748
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City | SOUTHBURY
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State | CT
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Zip | 06488-0748
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Country | US
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Telephone | 203-629-3880
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Fax | 203-262-6593
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20135
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License Number State | CT
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