MEDICARE: FITZCLAUD GRANT 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	174400000X	Specialist	178889	NY

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

General Provider Information

NPI Number	:	1194893990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FITZCLAUD GRANT M.D.

Provider Business Mailing Address
First Line	:	444 ELMONT RD
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-3529
Country	:	US
Telephone Number	:	516-488-3581
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 ELMONT RD
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-3529
Country	:	US
Telephone Number	:	516-488-3581
Fax Number	:

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/08/2007

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Directions to “ FITZCLAUD GRANT M.D.” Practice Location

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