Provider Demographics
NPI:1093701278
Name:GRANT, JOHN ANDREW (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANDREW
Last Name:GRANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MERRICK ROAD
Mailing Address - Street 2:SUITE 100W
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-632-7050
Mailing Address - Fax:516-632-7074
Practice Address - Street 1:100 MERRICK ROAD
Practice Address - Street 2:SUITE 100W
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-632-7050
Practice Address - Fax:516-632-7074
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0847982086S0120X
KS04-31027207T00000X
NY264268207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO32553028OtherBCBS KANSAS CITY
MO208392217Medicaid
KS100149820DMedicaid
KS513490OtherFIRSTGUARD
ILG20755Medicare UPIN
MO32553028OtherBCBS KANSAS CITY
MO208392217Medicaid