Provider Demographics
NPI:1174272280
Name:GRANGER, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:GRANGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4691
Mailing Address - Country:US
Mailing Address - Phone:812-949-0405
Mailing Address - Fax:812-949-0445
Practice Address - Street 1:2305 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4691
Practice Address - Country:US
Practice Address - Phone:812-949-0405
Practice Address - Fax:812-949-0445
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01096874A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics