Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 45470 | MA |
NPI | 1073550695 |
---|---|
Provider Name | Grannum R Sant |
First Address | Gloucester, MA 01930-1343 |
Second Address | Bridgewater, NJ 08807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 08/07/2007 |