Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | S01909 PT | MD |
N | 111NI0013X | Independent Medical Examiner | S01909-PT | MD |
N | 111NN0400X | Neurology | S01909-PT | MD |
Y | 111NR0400X | Rehabilitation Chiropractor | S01909-PT | MD |
N | 111NX0100X | Occupational Health | S01909-PT | MD |
NPI | 1144274994 |
---|---|
Provider Name | Nicholas Anthony Grande |
First Address | Crofton, MD 21114-1323 |
Second Address | Crofton, MD 21114-1336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 23/04/2021 |