Provider Demographics
NPI:1134107527
Name:GRANT, PHILIP WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:WAYNE
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:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-0291
Mailing Address - Country:US
Mailing Address - Phone:603-883-4636
Mailing Address - Fax:603-883-6854
Practice Address - Street 1:6 TSIENNETO RD STE 100LL
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-1584
Practice Address - Country:US
Practice Address - Phone:603-883-4636
Practice Address - Fax:603-883-6854
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH80562085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3072627Medicaid
NHB98811Medicare UPIN
NH80000400Medicaid