Provider Demographics
NPI:1073686838
Name:GRANDHI, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GRANDHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 PHILADELPHIA DR
Mailing Address - Street 2:441
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1840
Mailing Address - Country:US
Mailing Address - Phone:937-734-4690
Mailing Address - Fax:
Practice Address - Street 1:2200 PHILADELPHIA DR
Practice Address - Street 2:441
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1840
Practice Address - Country:US
Practice Address - Phone:937-734-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084640207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine