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General NPI Number Information
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NPI Number | 1639138209
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Entity Type | Individual
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Provider Name | GRANT MCCANN MUSSMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 02/18/2015
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Provider Practice Location Address
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Address Line | 7777 YANKEE ROAD ML 16026
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City | LIBERTY TOWNSHIP
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State | OH
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Zip | 45044-3500
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Country | US
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Telephone | 513-803-9649
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Fax | 513-803-9659
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Provider Business Mailing Address
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Address Line | 7777 YANKEE ROAD ML 16026
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City | LIBERTY TOWNSHIP
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State | OH
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Zip | 45044-3500
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Country | US
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Telephone | 513-803-9649
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Fax | 513-803-9659
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 90067
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License Number State | OH
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