MEDICARE: DR. DAVID THOMAS GRANDE 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
1	207R00000X	Internal Medicine Physician	MD421398	PA

General Provider Information

NPI Number	:	1518978782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID THOMAS GRANDE MD

Provider Business Mailing Address
First Line	:	3701 MARKET STREET
Second Line	:	7TH FLOOR, SUITE 741
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5502
Country	:	US
Telephone Number	:	215-349-5200
Fax Number	:	215-615-0038

Provider Business Practice Location Address
First Line	:	3701 MARKET STREET
Second Line	:	7TH FLOOR, SUITE 741
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-5502
Country	:	US
Telephone Number	:	215-349-5200
Fax Number	:	215-615-0038

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	05/08/2012

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