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NPI Code Detail

MEDICARE: MRS. GWYNETH GRANTON MD

MEDICARE: MRS. GWYNETH GRANTON MD
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
1207R00000XInternal Medicine PhysicianMD07266RI

General Provider Information

NPI Number : 1336132935
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GWYNETH GRANTON MD
Provider Business Mailing Address
First Line : 375 ALLENS AVE
Second Line :
City : PROVIDENCE
State : RI
Zip : 02905-5010
Country : US
Telephone Number : 440-144-4040
Fax Number : 401-444-0468
Provider Business Practice Location Address
First Line : 40 CANDACE ST
Second Line :
City : PROVIDENCE
State : RI
Zip : 02908-3747
Country : US
Telephone Number : 401-444-0550
Fax Number : 401-444-0425
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 08/29/2007

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Directions to “ MRS. GWYNETH GRANTON MD” Practice Location

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