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NPI Code Detail

MEDICARE: MARK ALAN GRAND MD

MEDICARE:   MARK ALAN GRAND  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 Physician1539331NY
2207RH0000XHematology (Internal Medicine) Physician153933NY
3207RX0202XMedical Oncology Physician153933NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487696514
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK ALAN GRAND MD
Provider Business Mailing Address
First Line : 55 WATER ST
Second Line : 12TH FLOOR - CREDENTIALING
City : NEW YORK
State : NY
Zip : 10041-0004
Country : US
Telephone Number : 646-680-2888
Fax Number : 516-542-5556
Provider Business Practice Location Address
First Line : 447 ATLANTIC AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11217-1702
Country : US
Telephone Number : 718-858-6300
Fax Number : 718-858-0145
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 09/12/2019

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