Provider Demographics
NPI:1083603526
Name:GRANGER, BRADFORD D (MD)
Entity Type:Individual
Prefix:
First Name:BRADFORD
Middle Name:D
Last Name:GRANGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2110 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17604-3200
Mailing Address - Country:US
Mailing Address - Phone:717-544-3191
Mailing Address - Fax:717-544-3637
Practice Address - Street 1:2110 HARRISBURG PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17604-3200
Practice Address - Country:US
Practice Address - Phone:717-544-3191
Practice Address - Fax:717-544-3637
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD421982207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019597180001Medicaid
PA1441611OtherHIGHMARK BLUE SHIELD
PAP004950OtherGATEWAY HEALTH PLAN
PAH67285OtherHEALTH ASSURANCE
PA1531655OtherGATEWAY HEALTH PLAN
PA50012584OtherCAPITAL BLUE CROSS
PA83116 S1QAOtherGEISINGER HEALTH PLAN
PAP00065632OtherRAILROAD MEDICARE
PA7684425OtherAETNA NON-HMO
PA1130420OtherAETNA HMO
PAP004950OtherGATEWAY HEALTH PLAN
PA1130420OtherAETNA HMO