Provider Demographics
NPI:1083722201
Name:OSCAR H GRANDAS MD PLLC
Entity Type:Organization
Organization Name:OSCAR H GRANDAS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:H
Authorized Official - Last Name:GRANDAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-544-6050
Mailing Address - Street 1:DEPT 888062
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37995-8062
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6158
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:E120
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-305-6050
Practice Address - Fax:865-305-8166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN388512086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH31517Medicare UPIN
TNDF4663Medicare PIN
TN3735196Medicare PIN