MEDICARE: MICHAEL A GRANOVSKY 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	207P00000X	Emergency Medicine Physician	D0046947	MD

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	76881001	OTHER	MD	MARYLAND BLUE SHIELD
4	H9140003	OTHER	DC	DC BLUE SHIELD

General Provider Information

NPI Number	:	1881655652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL A GRANOVSKY MD

Provider Business Mailing Address
First Line	:	PO BOX 500
Second Line	:
City	:	MARSHALL
State	:	VA
Zip	:	20116-0500
Country	:	US
Telephone Number	:	301-686-9010
Fax Number	:

Provider Business Practice Location Address
First Line	:	11711 LIVINGSTON RD
Second Line	:
City	:	FT WASHINGTON
State	:	MD
Zip	:	20744-5151
Country	:	US
Telephone Number	:	301-203-2250
Fax Number	:

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	02/09/2012

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