Provider Demographics
NPI:1164495750
Name:GRAMINS, DANIEL LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LAWRENCE
Last Name:GRAMINS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:VETERANS ADMINISTRATION MEDICAL CTR
Mailing Address - Street 2:3350 LA JOLLA VILLAGE DRIVE (112J)
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-8892
Mailing Address - Country:US
Mailing Address - Phone:858-552-8585
Mailing Address - Fax:858-552-7530
Practice Address - Street 1:VETERANS ADMINISTRATION MEDICAL CTR
Practice Address - Street 2:3350 LA JOLLA VILLAGE DRIVE (112J)
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-8892
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:858-552-7530
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG79711208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G797110OtherBLUE SHIELD OF CA
CA00G797110Medicaid
WG79711AMedicare PIN