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General NPI Number Information
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NPI Number | 1851477566
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Entity Type | Organization
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Legal Business Name | M. GRETCHEN GRANT, MD
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 09/25/2007
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Provider Practice Location Address
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Address Line | 989 ROUTE 146 STE 300 SUITE 303
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City | CLIFTON PARK
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State | NY
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Zip | 12065-3647
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Country | US
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Telephone | 518-371-3391
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Fax |
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Provider Business Mailing Address
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Address Line | 989 ROUTE 146 STE 300 SUITE 303
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City | CLIFTON PARK
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State | NY
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Zip | 12065-3647
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Country | US
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Telephone | 518-371-3391
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. M GRETCHEN GRANT
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Credential | MD
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Telephone | 518-371-3391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 142726
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License Number State | NY
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