MEDICARE: DR. CARRON ROSE GRANT DPM

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	213ES0000X	Sports Medicine Podiatrist	01441	MD

General Provider Information

NPI Number	:	1700997400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARRON ROSE GRANT DPM

Provider Business Mailing Address
First Line	:	2101 E JEFFERSON ST
Second Line	:	KAISER PERMANENTE MEDICARE ENROLLMENT
City	:	ROCKVILLE
State	:	MD
Zip	:	20852-4908
Country	:	US
Telephone Number	:	301-816-2424
Fax Number	:

Provider Business Practice Location Address
First Line	:	1447 YORK RD STE 100
Second Line	:
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-6074
Country	:	US
Telephone Number	:	410-339-5500
Fax Number	:

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	06/27/2021

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