MEDICARE: BRADFORD D GRANGER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD421982	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	P00065632	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1441611	OTHER	PA	HIGHMARK BLUE SHIELD
3	P004950	OTHER	PA	GATEWAY HEALTH PLAN
4	H67285	OTHER	PA	HEALTH ASSURANCE
5	1531655	OTHER	PA	GATEWAY HEALTH PLAN
6	50012584	OTHER	PA	CAPITAL BLUE CROSS
7	83116 S1QA	OTHER	PA	GEISINGER HEALTH PLAN
9	7684425	OTHER	PA	AETNA NON-HMO
10	1130420	OTHER	PA	AETNA HMO

General Provider Information

NPI Number	:	1083603526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADFORD D GRANGER M.D.

Provider Business Mailing Address
First Line	:	2110 HARRISBURG PIKE
Second Line	:	SUITE 100
City	:	LANCASTER
State	:	PA
Zip	:	17604-3200
Country	:	US
Telephone Number	:	717-544-3191
Fax Number	:	717-544-3637

Provider Business Practice Location Address
First Line	:	2110 HARRISBURG PIKE
Second Line	:	SUITE 100
City	:	LANCASTER
State	:	PA
Zip	:	17604-3200
Country	:	US
Telephone Number	:	717-544-3191
Fax Number	:	717-544-3637

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	09/05/2007

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Directions to “ BRADFORD D GRANGER M.D.” Practice Location

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