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General NPI Number Information
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NPI Number | 1720032238
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Entity Type | Individual
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Provider Name | RONN A. GRANDIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 12075 JERRYS RUN RD
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City | APPLE GROVE
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State | WV
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Zip | 25502
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Country | US
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Telephone | 304-546-0854
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX B
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City | FRAZIERS BOTTOM
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State | WV
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Zip | 25082-0251
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Country | US
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Telephone |
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35-06-1980
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 18530
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License Number State | WV
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