Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | D0064297 | MD |
NPI | 1124139233 |
---|---|
Provider Name | David A Granger |
First Address | Germantown, MD 20874-1214 |
Second Address | Germantown, MD 20874-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |